Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | A122864 | CA |
NPI | 1093087504 |
---|---|
Provider Name | Jelena Maletkovic |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Porter Ranch, CA 91326-4141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2012 |
Last Update Date | 02/07/2020 |