Provider Demographics
NPI:1902533623
Name:DOMNARU, IOANA ALEXANDRA (MA49003)
Entity Type:Individual
Prefix:
First Name:IOANA
Middle Name:ALEXANDRA
Last Name:DOMNARU
Suffix:
Gender:F
Credentials:MA49003
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 NE 23RD ST APT 611
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5069
Mailing Address - Country:US
Mailing Address - Phone:305-778-5403
Mailing Address - Fax:
Practice Address - Street 1:423 NE 23RD ST APT 611
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5069
Practice Address - Country:US
Practice Address - Phone:305-778-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49003225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist