Healthcare Provider Details

I. General information

NPI: 1902329741
Provider Name (Legal Business Name): DANOVA ANDREA LOPEZ FAJERSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10624 S EASTERN AVE # A-955
HENDERSON NV
89052-2982
US

IV. Provider business mailing address

10624 S EASTERN AVE # A-955
HENDERSON NV
89052-2982
US

V. Phone/Fax

Practice location:
  • Phone: 702-407-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number272462
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number29958
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: