Provider Demographics
NPI:1649900721
Name:FARINHA, DAMIEN PERRY (SUB IDC)
Entity type:Individual
Prefix:
First Name:DAMIEN
Middle Name:PERRY
Last Name:FARINHA
Suffix:
Gender:M
Credentials:SUB IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS JEFFERSON CITY (SSN 759)
Mailing Address - Street 2:UNIT 100146 BOX 1
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96669-2415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS JEFFERSON CITY (SSN 759)
Practice Address - Street 2:NAVAL STATION GUAM
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96669-2415
Practice Address - Country:US
Practice Address - Phone:671-482-4953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman