Provider Demographics
NPI:1114080843
Name:CROITORU, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CROITORU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 NE 192ND ST APT 2106
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2459
Mailing Address - Country:US
Mailing Address - Phone:678-698-8788
Mailing Address - Fax:
Practice Address - Street 1:3400 NE 192ND ST APT 2106
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2459
Practice Address - Country:US
Practice Address - Phone:678-698-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812150800Medicaid