Provider Demographics
NPI:1992567267
Name:DAMASO, MARCVON VINCE
Entity type:Individual
Prefix:
First Name:MARCVON VINCE
Middle Name:
Last Name:DAMASO
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 1:94-440 KAHUALEI PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3535
Mailing Address - Country:US
Mailing Address - Phone:808-824-7381
Mailing Address - Fax:
Practice Address - Street 1:94-440 KAHUALEI PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3535
Practice Address - Country:US
Practice Address - Phone:808-824-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1220065253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency