=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255541256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAMIANO DE SANO IOCOVOZZI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34131 DATE PALM DR
-----------------------------------------------------
City | CATHEDRAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92234-6884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-770-4600
-----------------------------------------------------
Fax | 760-770-1564
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 627 POPPY ST
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92262-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-323-3517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP10685
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------