Provider Demographics
NPI:1780891598
Name:POOLE, DAMONE LUSHON (PA,MPA,NHA)
Entity type:Individual
Prefix:
First Name:DAMONE
Middle Name:LUSHON
Last Name:POOLE
Suffix:
Gender:M
Credentials:PA,MPA,NHA
Other - Prefix:
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Mailing Address - Street 1:1126 REGATTA PT
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-2607
Mailing Address - Country:US
Mailing Address - Phone:510-741-8038
Mailing Address - Fax:510-235-8650
Practice Address - Street 1:2600 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1826
Practice Address - Country:US
Practice Address - Phone:510-236-8484
Practice Address - Fax:510-235-8650
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15735363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical