Provider Demographics
NPI:1245705045
Name:DAMIAN, SANDRA KARINIE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KARINIE
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 1:889 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360-1149
Mailing Address - Country:US
Mailing Address - Phone:209-277-2537
Mailing Address - Fax:
Practice Address - Street 1:6400 TUPELO DR
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1741
Practice Address - Country:US
Practice Address - Phone:916-729-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other