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General NPI Number Information
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NPI Number | 1083748248
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Entity Type | Organization
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Legal Business Name | CENTER FOR DEVELOPING MINDS MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15951 LOS GATOS BLVD SUITE 6
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City | LOS GATOS
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State | CA
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Zip | 95032-3428
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Country | US
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Telephone | 408-358-1853
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Fax |
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Provider Business Mailing Address
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Address Line | 22990 SCHULTIES RD
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City | LOS GATOS
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State | CA
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Zip | 95033-8703
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Country | US
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Telephone | 408-358-1853
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DAMON RUSSELL KORB
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Credential | M.D.
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Telephone | 408-358-1853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | A62686
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License Number State | CA
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