Provider Demographics
NPI:1023263340
Name:LANI, MANIJEH E (FNP)
Entity type:Individual
Prefix:
First Name:MANIJEH
Middle Name:E
Last Name:LANI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:DR
Other - First Name:MANIJEH
Other - Middle Name:E
Other - Last Name:LANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, ND
Mailing Address - Street 1:1701 SKYHILL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2585
Mailing Address - Country:US
Mailing Address - Phone:714-501-3383
Mailing Address - Fax:
Practice Address - Street 1:1215 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2237
Practice Address - Country:US
Practice Address - Phone:949-910-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF11200078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF11200078OtherFNP BOARD CERTIFIED