Individual
DAMIEN SHEPPARD I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
45004 ALTISSIMO WAY, LAKE ELSINORE, CA 92532-1523
(951) 768-6698
Mailing address
45004 ALTISSIMO WAY, LAKE ELSINORE, CA 92532-1523
(951) 768-6698
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
00056962
CA
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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