Provider Demographics
NPI:1033913504
Name:FAGARANG, DONNA G
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:G
Last Name:FAGARANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26920 WINDING TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91381-2186
Mailing Address - Country:US
Mailing Address - Phone:910-574-0244
Mailing Address - Fax:
Practice Address - Street 1:27141 HIDAWAY AVE STE 106
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-4135
Practice Address - Country:US
Practice Address - Phone:661-252-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily