Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT12974TPA | CA |
NPI | 1013002179 |
---|---|
Provider Name | Diana Mihaela Ciobanu |
First Address | Mission Viejo, CA 92691-6515 |
Second Address | Mission Viejo, CA 92691-6515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 01/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V08845 | (02) | CA |