Provider Demographics
NPI:1295047488
Name:DAMICO, LORI L
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:DAMICO
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 1:1432 VISTA DEL CIUDAD DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-2203
Mailing Address - Country:US
Mailing Address - Phone:702-346-5941
Mailing Address - Fax:702-346-5941
Practice Address - Street 1:1432 VISTA DEL CIUDAD DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-2203
Practice Address - Country:US
Practice Address - Phone:702-346-5941
Practice Address - Fax:702-346-5941
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101444298172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker