Healthcare Provider Details

I. General information

NPI: 1043891054
Provider Name (Legal Business Name): DANICA WITTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 WORSHAM AVE STE 100
LONG BEACH CA
90808-1734
US

IV. Provider business mailing address

3747 WORSHAM AVE STE 100
LONG BEACH CA
90808-1734
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-4513
  • Fax:
Mailing address:
  • Phone: 562-430-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA20834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: