Provider Demographics
NPI:1417119827
Name:CARCAMO-MOLINA, DAYANA OTHONIE (MD)
Entity Type:Individual
Prefix:
First Name:DAYANA
Middle Name:OTHONIE
Last Name:CARCAMO-MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAYANA
Other - Middle Name:OTHONIE
Other - Last Name:CARCAMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1007 41ST ST APT 441
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3778
Mailing Address - Country:US
Mailing Address - Phone:310-948-4221
Mailing Address - Fax:
Practice Address - Street 1:2351 CLAY ST STE 380
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1931
Practice Address - Country:US
Practice Address - Phone:415-600-3954
Practice Address - Fax:415-775-7437
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9406987207R00000X
CAA11529207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine