Provider Demographics
NPI:1174535017
Name:CRILEY, JASMINKA MARIA
Entity type:Individual
Prefix:
First Name:JASMINKA
Middle Name:MARIA
Last Name:CRILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JASMINKA
Other - Middle Name:
Other - Last Name:VUKANOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:46 PENINSULA CTR # 347
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3506
Mailing Address - Country:US
Mailing Address - Phone:310-541-2830
Mailing Address - Fax:
Practice Address - Street 1:1050 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-491-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72281Medicare UPIN