Basic Information
| Provider Information | |||||||||
| NPI: | 1700862539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SACCO | ||||||||
| FirstName: | DAMON | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6102 | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949486102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158843418 | ||||||||
| FaxNumber: | 4158838082 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 BON AIR RD | ||||||||
| Address2: | |||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949041702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159257080 | ||||||||
| FaxNumber: | 4158838082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 25MA07213700 | NJ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | G59549 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1700862539 | 05 | NV | MEDICAID | 8933496 | 01 | WA | L&I, CVCP | OTHER | 00G595490 | 05 | CA | MEDICAID | 200097380A | 05 | OK | MEDICAID | 8940304 | 05 | NJ | MEDICAID | 0144893 | 01 | WA | L&I | OTHER | P00327251 | 01 | AZ | RAILROAD MEDICARE | OTHER | 111189 | 05 | AZ | MEDICAID | 1307792 | 05 | CO | MEDICAID | 8169682 | 05 | WA | MEDICAID | 300121758 | 01 | CA | RAILROAD MEDICARE | OTHER | 300123272 | 01 | WA | RAILROAD MEDICARE | OTHER |