Provider Demographics
NPI:1487327508
Name:MATIJEVIC, JELENA (DMD)
Entity type:Individual
Prefix:DR
First Name:JELENA
Middle Name:
Last Name:MATIJEVIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 CALLE ARQUERO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-2716
Mailing Address - Country:US
Mailing Address - Phone:817-876-1019
Mailing Address - Fax:
Practice Address - Street 1:1830 HACIENDA DR STE 1
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-4544
Practice Address - Country:US
Practice Address - Phone:760-295-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist