Provider Demographics
NPI:1457385619
Name:KRSTIC, MARIJA (MD)
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:
Last Name:KRSTIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:4275 BURNHAM AVE
Practice Address - Street 2:270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5488
Practice Address - Country:US
Practice Address - Phone:702-946-5399
Practice Address - Fax:702-946-5424
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV145385619Medicaid
NV11879OtherSTATE LICENSE
NV102804Medicare PIN