Provider Demographics
NPI:1922772086
Name:MLADENOVIC, MONIKA
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:MLADENOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 VENTURA BLVD STE 630
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16260 VENTURA BLVD STE 630
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2255
Practice Address - Country:US
Practice Address - Phone:747-998-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2024-01-19
Deactivation Date:2024-01-12
Deactivation Code:
Reactivation Date:2024-01-19
Provider Licenses
StateLicense IDTaxonomies
CA95028464363LP0808X
CA95222082163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health