Provider Demographics
NPI:1467465120
Name:CERNAIANU, MIRELA
Entity Type:Individual
Prefix:MS
First Name:MIRELA
Middle Name:
Last Name:CERNAIANU
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 1:3180 WILLOW LN
Mailing Address - Street 2:SUITE 108
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4941
Mailing Address - Country:US
Mailing Address - Phone:805-815-5215
Mailing Address - Fax:888-972-9656
Practice Address - Street 1:3180 WILLOW LN
Practice Address - Street 2:SUITE 108
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4941
Practice Address - Country:US
Practice Address - Phone:805-815-5215
Practice Address - Fax:888-972-9656
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79539207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A795390Medicaid
H44943Medicare UPIN
CA00A795390Medicaid