Provider Demographics
NPI:1013379189
Name:DAMENTO, GENA (MD)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:DAMENTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 VAN NESS AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3272
Mailing Address - Country:US
Mailing Address - Phone:520-235-3680
Mailing Address - Fax:
Practice Address - Street 1:711 VAN NESS AVE STE 250
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3272
Practice Address - Country:US
Practice Address - Phone:415-600-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA151234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology