Healthcare Provider Details

I. General information

NPI: 1780507236
Provider Name (Legal Business Name): JOHN DAMERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN F DAME

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N DEWITT AVE
CLOVIS CA
93612-1066
US

IV. Provider business mailing address

3700 LOMA VISTA PKWY APT 2606
CLOVIS CA
93619-9841
US

V. Phone/Fax

Practice location:
  • Phone: 559-477-5546
  • Fax:
Mailing address:
  • Phone: 559-293-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberD5373655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: