Provider Demographics
NPI:1962460154
Name:MOURANI, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MOURANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OUSAMA
Other - Middle Name:
Other - Last Name:MOURANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:310 N INDIAN HILL BLVD
Mailing Address - Street 2:PMB # 801
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4611
Mailing Address - Country:US
Mailing Address - Phone:909-275-7470
Mailing Address - Fax:909-971-4532
Practice Address - Street 1:255 E BONITA AVE BLDG 1B
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-275-7470
Practice Address - Fax:909-971-4532
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80001207RI0200X
AZ33022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A800010Medicaid
CAI17325Medicare UPIN
AZI17325Medicare UPIN