Provider Demographics
NPI:1700841582
Name:DAMASCO-GUTIERREZ, DAISY CUBE (MD)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:CUBE
Last Name:DAMASCO-GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:CUBE
Other - Last Name:DAMASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:386 E H ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7485
Mailing Address - Country:US
Mailing Address - Phone:619-427-5053
Mailing Address - Fax:619-427-1437
Practice Address - Street 1:386 E H ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7485
Practice Address - Country:US
Practice Address - Phone:619-427-5053
Practice Address - Fax:619-427-1437
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A669930Medicaid
CA00A669930Medicaid