Provider Demographics
NPI:1437036837
Name:DAMIAN, MAYRA CECILIA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:CECILIA
Last Name:DAMIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3841
Mailing Address - Country:US
Mailing Address - Phone:831-637-5393
Mailing Address - Fax:831-637-0140
Practice Address - Street 1:460 5TH ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3841
Practice Address - Country:US
Practice Address - Phone:831-637-5393
Practice Address - Fax:831-637-0140
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker