Provider Demographics
NPI:1073809067
Name:GASANOVA, DONARA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DONARA
Middle Name:
Last Name:GASANOVA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14860 ROSCOE BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4691
Mailing Address - Country:US
Mailing Address - Phone:747-998-0387
Mailing Address - Fax:747-201-4700
Practice Address - Street 1:14860 ROSCOE BLVD STE 307
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4691
Practice Address - Country:US
Practice Address - Phone:747-998-0387
Practice Address - Fax:747-201-4700
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN722878163WP0809X
CA95018451363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult