Provider Demographics
NPI:1649726969
Name:DAMANI, SUNITA
Entity type:Individual
Prefix:
First Name:SUNITA
Middle Name:
Last Name:DAMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21515 HAWTHORNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6512
Mailing Address - Country:US
Mailing Address - Phone:714-786-0062
Mailing Address - Fax:855-801-8296
Practice Address - Street 1:21515 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6512
Practice Address - Country:US
Practice Address - Phone:714-786-0062
Practice Address - Fax:855-801-8296
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2815446347E00000X
CAC2915446343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker