NPIMap

Organization Active NPI

Minerva Mental Health P.C.

  • Psychiatry Physician
  • Los Angeles, CA
National Provider Identifier
1982140901
Registry record updated Jan 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A91413 Issued in CA
Legal business name
MINERVA MENTAL HEALTH P.C.
Practice address
4448 Ambrose Ave
Los Angeles, CA 90027-2115
Phone
(323) 644-1998
Fax
(323) 644-2600
NPI assigned
Jan 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Milica Stefanovic, M.D.
Title
President
Phone
(323) 644-1998

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X A91413 CA Primary

Addresses

Primary practice location

4448 Ambrose Ave
Los Angeles, CA 90027-2115

Mailing address

4448 Ambrose Ave
Los Angeles, CA 90027-2115
Phone (323) 644-1998

National Provider Directory

National Provider Directory

Locations

363 Route 111
Ste 107A
Smithtown, NY 11787
Phone (631) 209-4255

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1982140901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4448 AMBROSE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900272115",
            "telephone_number": "323-644-1998",
            "fax_number": "323-644-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4448 AMBROSE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900272115",
            "telephone_number": "323-644-1998",
            "fax_number": "323-644-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINERVA MENTAL HEALTH P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "STEFANOVIC",
        "authorized_official_first_name": "MILICA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-644-1998",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A91413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.