Healthcare Provider Details

I. General information

NPI: 1184256976
Provider Name (Legal Business Name): SHARON N DAMATO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/02/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13690 E 14TH ST STE 100
SAN LEANDRO CA
94578-2584
US

IV. Provider business mailing address

13690 E 14TH ST STE 100
SAN LEANDRO CA
94578-2584
US

V. Phone/Fax

Practice location:
  • Phone: 510-984-2489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: