Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A95251 | CA |
Y | 2080P0205X | Pediatric Endocrinologist | A95251 | CA |
NPI | 1053469767 |
---|---|
Provider Name | Maja Marinkovic |
First Address | San Diego, CA 92123-4800 |
Second Address | San Diego, CA 92123-2758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 25/08/2011 |