Basic Information
| Provider Information | |||||||||
| NPI: | 1710268198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASCUAL | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | MALTEZO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1597 N MATHEW ST | ||||||||
| Address2: | |||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932576646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593599208 | ||||||||
| FaxNumber: | 6618498106 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NORTH K STREET | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596870929 | ||||||||
| FaxNumber: | 5596858953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2011 | ||||||||
| LastUpdateDate: | 08/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.