Provider Demographics
NPI:1932204351
Name:HASTERT, DONNA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:HASTERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8516
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-0516
Mailing Address - Country:US
Mailing Address - Phone:951-672-7673
Mailing Address - Fax:
Practice Address - Street 1:27640 ENCANTO DR
Practice Address - Street 2:SUITE B
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-4542
Practice Address - Country:US
Practice Address - Phone:951-672-7673
Practice Address - Fax:951-672-1197
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant