Provider Demographics
NPI:1396047361
Name:STEPHEN M DAMIANI, D.O., INC
Entity type:Organization
Organization Name:STEPHEN M DAMIANI, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:DAMIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-946-3366
Mailing Address - Street 1:18092 WIKA RD
Mailing Address - Street 2:STE 110
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2132
Mailing Address - Country:US
Mailing Address - Phone:760-946-3366
Mailing Address - Fax:760-946-3866
Practice Address - Street 1:18092 WIKA RD
Practice Address - Street 2:STE 110
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2132
Practice Address - Country:US
Practice Address - Phone:760-946-3366
Practice Address - Fax:760-946-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty