Provider Demographics
NPI:1083133250
Name:POPESCU, OANA-DIANA (PA)
Entity Type:Individual
Prefix:
First Name:OANA-DIANA
Middle Name:
Last Name:POPESCU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:OANA-DIANA
Other - Middle Name:
Other - Last Name:BURLUC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27068 LA PAZ RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24401 MUIRLANDS BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3948
Practice Address - Country:US
Practice Address - Phone:949-770-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant