Provider Demographics
NPI:1952412157
Name:MITREVSKI, PREDRAG P (MD)
Entity Type:Individual
Prefix:
First Name:PREDRAG
Middle Name:P
Last Name:MITREVSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 CAMINO DE LOS MARES STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2836
Mailing Address - Country:US
Mailing Address - Phone:949-542-8865
Mailing Address - Fax:949-276-2367
Practice Address - Street 1:675 CAMINO DE LOS MARES STE 200
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2836
Practice Address - Country:US
Practice Address - Phone:949-542-8865
Practice Address - Fax:949-276-2367
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI39154Medicare UPIN
WA90453AMedicare PIN