Basic Information
| Provider Information | |||||||||
| NPI: | 1841254489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DO | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | RNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13203 DEMING AVE | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625317362 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1771 W ROMNEYA DR | ||||||||
| Address2: | STE C | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145203000 | ||||||||
| FaxNumber: | 7145205742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 8925 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | GR0095540 | 05 | CA | MEDICAID |