Healthcare Provider Details

I. General information

NPI: 1710268198
Provider Name (Legal Business Name): DONNA MALTEZO PASCUAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTH K STREET
TULARE CA
93274
US

IV. Provider business mailing address

1597 N MATHEW ST
PORTERVILLE CA
93257-6646
US

V. Phone/Fax

Practice location:
  • Phone: 559-687-0929
  • Fax: 559-685-8953
Mailing address:
  • Phone: 559-359-9208
  • Fax: 661-849-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: