Provider Demographics
NPI:1285915728
Name:DJURIC, MARIA ROMAN (RN)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ROMAN
Last Name:DJURIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:ROMAN
Other - Last Name:BROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3851 ROSECRANS ST STE 704
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-542-4121
Mailing Address - Fax:619-692-5677
Practice Address - Street 1:3851 ROSECRANS ST STE 704
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-542-4121
Practice Address - Fax:619-692-5677
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse