Provider Demographics
NPI:1548463342
Name:DAMON, MIRIAM (RN MFT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:DAMON
Suffix:
Gender:F
Credentials:RN MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 HOWARD ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3761
Mailing Address - Fax:415-255-3567
Practice Address - Street 1:1380 HOWARD ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2638
Practice Address - Country:US
Practice Address - Phone:415-255-3761
Practice Address - Fax:415-255-3567
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN304924163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
50OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
50OtherSFGH INTERNAL USE ONLY