Healthcare Provider Details

I. General information

NPI: 1821912544
Provider Name (Legal Business Name): HUTHAIFA BANY HUTHAIL PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40145 WHITE LEAF LN
MURRIETA CA
92562-3809
US

IV. Provider business mailing address

40145 WHITE LEAF LN
MURRIETA CA
92562-3809
US

V. Phone/Fax

Practice location:
  • Phone: 714-718-3992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number343617
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: