=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033913504
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA G FAGARANG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2025
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27141 HIDAWAY AVE STE 106
-----------------------------------------------------
City | CANYON COUNTRY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91351-4135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-252-8469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26920 WINDING TRAIL CT
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91381-2186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-574-0244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95033926
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------