Provider Demographics
NPI:1447429584
Name:ITANI, ABDALLAH OMAR (DPT)
Entity Type:Individual
Prefix:MR
First Name:ABDALLAH
Middle Name:OMAR
Last Name:ITANI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1111 W TOWN AND COUNTRY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4615
Mailing Address - Country:US
Mailing Address - Phone:714-997-5518
Mailing Address - Fax:714-744-2650
Practice Address - Street 1:1111 W TOWN AND COUNTRY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4615
Practice Address - Country:US
Practice Address - Phone:714-997-5518
Practice Address - Fax:714-744-2650
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34438174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist