Provider Demographics
NPI:1558889725
Name:ITANI MOUSA, DANIA (DNP, FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:DANIA
Middle Name:
Last Name:ITANI MOUSA
Suffix:
Gender:F
Credentials:DNP, FNP-C, RN
Other - Prefix:
Other - First Name:DANIA
Other - Middle Name:
Other - Last Name:AL-ITANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 LONG BEACH BLVD PH 1101
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5019
Mailing Address - Country:US
Mailing Address - Phone:714-313-1775
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2784
Practice Address - Country:US
Practice Address - Phone:844-822-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner