Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 14162949 | CA |
NPI | 1053086223 |
---|---|
Provider Name | Mrs. Michelle Catherine D'amato |
First Address | San Diego, CA 92111-5641 |
Second Address | San Diego, CA 92111-5641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2021 |
Last Update Date | 10/08/2021 |