Provider Demographics
NPI:1285468397
Name:ORELLANA, DAMARIS SARAI (ATC)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:SARAI
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S MACY ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2042
Mailing Address - Country:US
Mailing Address - Phone:909-265-2627
Mailing Address - Fax:
Practice Address - Street 1:7447 SCHOLAR WAY
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-4019
Practice Address - Country:US
Practice Address - Phone:951-738-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2000056251207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine