Healthcare Provider Details

I. General information

NPI: 1811504418
Provider Name (Legal Business Name): DAYNA DEWITT MATAISZ PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11027 BURBANK BLVD
NORTH HOLLYWOOD CA
91601-2431
US

IV. Provider business mailing address

11027 BURBANK BLVD
NORTH HOLLYWOOD CA
91601-2431
US

V. Phone/Fax

Practice location:
  • Phone: 818-985-8323
  • Fax:
Mailing address:
  • Phone: 818-985-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: