Provider Demographics
NPI:1083092191
Name:DAMASEN, DEANNA (LAC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:DAMASEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:SANTILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 HALE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4133
Mailing Address - Country:US
Mailing Address - Phone:707-280-5193
Mailing Address - Fax:
Practice Address - Street 1:827 1ST ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3201
Practice Address - Country:US
Practice Address - Phone:707-280-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16418171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist