Provider Demographics
NPI:1972330512
Name:DAMICO, KRISTOFER
Entity type:Individual
Prefix:
First Name:KRISTOFER
Middle Name:
Last Name:DAMICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 JEFFREYS ST APT 2001
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7912
Mailing Address - Country:US
Mailing Address - Phone:407-342-9701
Mailing Address - Fax:
Practice Address - Street 1:10115 JEFFREYS ST APT 2001
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7912
Practice Address - Country:US
Practice Address - Phone:407-342-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant