Active NPI
Mirjana Jaksic, M.D.
- Pediatrics Physician
- Rancho Palos Verdes, CA
National Provider Identifier
1619219946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- AFE29308
- Practice address
- 2085 Chandeleur Dr
Rancho Palos Verdes, CA 90275-6371 - Phone
- (310) 519-7500
- Fax
- (310) 831-8740
- NPI assigned
- Mar 25, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | AFE29308 | CA | Primary |
Addresses
Primary practice location
2085 Chandeleur Dr
Rancho Palos Verdes, CA 90275-6371
Mailing address
2085 Chandeleur Dr
Rancho Palos Verdes, CA 90275-6371
Phone (310) 519-7500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AFE29308 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364169600000",
"number": "1619219946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2085 CHANDELEUR DR",
"city": "RANCHO PALOS VERDES",
"state": "CA",
"postal_code": "902756371",
"telephone_number": "310-519-7500",
"fax_number": "310-831-8740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2085 CHANDELEUR DR",
"city": "RANCHO PALOS VERDES",
"state": "CA",
"postal_code": "902756371",
"telephone_number": "310-519-7500",
"fax_number": "310-831-8740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAKSIC",
"first_name": "MIRJANA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-25",
"last_updated": "2013-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "AFE29308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Palos Verdes, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.