Healthcare Provider Details

I. General information

NPI: 1790427482
Provider Name (Legal Business Name): DAMARIS HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 PERKINS ST
SONOMA CA
95476-6826
US

IV. Provider business mailing address

2209 REDWOOD RD
NAPA CA
94558-3219
US

V. Phone/Fax

Practice location:
  • Phone: 707-249-3422
  • Fax:
Mailing address:
  • Phone: 707-249-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: