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General NPI Number Information
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NPI Number | 1376993147
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Entity Type | Organization
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Legal Business Name | DAMOAN CORP.
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 2801 OCEAN PARK BLVD STE 393
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City | SANTA MONICA
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State | CA
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Zip | 90405
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Country | US
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Telephone | 310-453-9608
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Fax | 310-315-4148
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Provider Business Mailing Address
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Address Line | 2801 OCEAN PARK BLVD STE 393
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City | SANTA MONICA
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State | CA
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Zip | 90405
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Country | US
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Telephone | 310-453-9608
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Fax | 310-315-4148
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MARTIN GONZALEZ
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Credential |
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Telephone | 310-453-9608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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