Provider Demographics
NPI:1104024355
Name:KANTARA, DANA NICOLE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:NICOLE
Last Name:KANTARA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:NADALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 ENCINO AVE
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2572
Mailing Address - Country:US
Mailing Address - Phone:281-636-1753
Mailing Address - Fax:281-484-1785
Practice Address - Street 1:10950 RESOURCE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6158
Practice Address - Country:US
Practice Address - Phone:281-484-5587
Practice Address - Fax:281-484-1785
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant