Provider Demographics
NPI:1013002179
Name:CIOBANU, DIANA MIHAELA (OD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MIHAELA
Last Name:CIOBANU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 THE SHOPS AT MISSION VIEJO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6515
Mailing Address - Country:US
Mailing Address - Phone:949-582-2020
Mailing Address - Fax:949-364-1837
Practice Address - Street 1:602 THE SHOPS AT MISSION VIEJO
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6515
Practice Address - Country:US
Practice Address - Phone:949-582-2020
Practice Address - Fax:949-364-1837
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12974TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP12974AMedicare ID - Type UnspecifiedPPIN
CAWOP12974BMedicare ID - Type UnspecifiedPPIN
CAV08845Medicare UPIN