Provider Demographics
NPI:1588119010
Name:MAGANA, DANIELLE FAVORS (AGNP-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:FAVORS
Last Name:MAGANA
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1202 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4089
Mailing Address - Country:US
Mailing Address - Phone:210-404-2650
Mailing Address - Fax:210-495-0261
Practice Address - Street 1:3166 SE MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3978
Practice Address - Country:US
Practice Address - Phone:210-298-4711
Practice Address - Fax:210-298-4717
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner