Provider Demographics
NPI:1033937107
Name:LYON, DAMIEN MATTHEW (RN)
Entity type:Individual
Prefix:MR
First Name:DAMIEN
Middle Name:MATTHEW
Last Name:LYON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 6TH AVE UNIT 516
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8963
Mailing Address - Country:US
Mailing Address - Phone:209-813-5096
Mailing Address - Fax:
Practice Address - Street 1:PSC 558 BOX 4068
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96375-0041
Practice Address - Country:US
Practice Address - Phone:080-419-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95148541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse