Provider Demographics
NPI:1710268198
Name:PASCUAL, DONNA MALTEZO
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MALTEZO
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 N MATHEW ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-6646
Mailing Address - Country:US
Mailing Address - Phone:559-359-9208
Mailing Address - Fax:661-849-8106
Practice Address - Street 1:201 NORTH K STREET
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274
Practice Address - Country:US
Practice Address - Phone:559-687-0929
Practice Address - Fax:559-685-8953
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program