Healthcare Provider Details

I. General information

NPI: 1013002179
Provider Name (Legal Business Name): DIANA MIHAELA CIOBANU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 THE SHOPS AT MISSION VIEJO
MISSION VIEJO CA
92691-6515
US

IV. Provider business mailing address

602 THE SHOPS AT MISSION VIEJO
MISSION VIEJO CA
92691-6515
US

V. Phone/Fax

Practice location:
  • Phone: 949-582-2020
  • Fax: 949-364-1837
Mailing address:
  • Phone: 949-582-2020
  • Fax: 949-364-1837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT12974TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: