Provider Demographics
NPI:1063675411
Name:DAMIANO, WILLIAM ANTHONY
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:DAMIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:ANTHONY
Other - Last Name:DAMIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2002 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3212
Mailing Address - Country:US
Mailing Address - Phone:707-268-3305
Mailing Address - Fax:
Practice Address - Street 1:2002 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3212
Practice Address - Country:US
Practice Address - Phone:707-268-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
946000513OtherEIN