Healthcare Provider Details

I. General information

NPI: 1346090602
Provider Name (Legal Business Name): FARIDA P DAMASO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MOHOULI ST
HILO HI
96720-7210
US

IV. Provider business mailing address

45 MOHOULI ST
HILO HI
96720-7210
US

V. Phone/Fax

Practice location:
  • Phone: 808-940-1654
  • Fax:
Mailing address:
  • Phone: 808-940-1654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-68075
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: