Healthcare Provider Details

I. General information

NPI: 1265814180
Provider Name (Legal Business Name): REBEKAH DAMAZO RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKAH THORP RN

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6888 DEAN PL
PARADISE CA
95969-2375
US

IV. Provider business mailing address

6888 DEAN PL
PARADISE CA
95969-2375
US

V. Phone/Fax

Practice location:
  • Phone: 530-591-5812
  • Fax:
Mailing address:
  • Phone: 530-591-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2667
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number246775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: