Provider Demographics
NPI:1679177406
Name:ITANI, MARIA BIBI
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:BIBI
Last Name:ITANI
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 1:1311 SEPULVEDA BLVD APT 342
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5133
Mailing Address - Country:US
Mailing Address - Phone:323-443-5288
Mailing Address - Fax:
Practice Address - Street 1:1311 SEPULVEDA BLVD APT 342
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-5133
Practice Address - Country:US
Practice Address - Phone:323-443-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-164803174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN