Provider Demographics
NPI:1063480986
Name:DRAPEAU-DAMATO, KASEY (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:
Last Name:DRAPEAU-DAMATO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:DRAPEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:990W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2155
Mailing Address - Country:US
Mailing Address - Phone:310-829-4484
Mailing Address - Fax:310-829-4481
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:990W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2155
Practice Address - Country:US
Practice Address - Phone:310-829-4484
Practice Address - Fax:310-829-4481
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16909363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW8759Medicare UPIN