Individual provider Active NPI

Genevive Damasco, RD

  • Registered Dietitian
  • Oakland, CA
National Provider Identifier
1215756820
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86372091 Issued in CA
Practice address
3451 E 12TH St
Oakland, CA 94601-3463
Phone
(510) 535-3700
NPI assigned
Oct 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 86372091 CA Primary

Addresses

Primary practice location

3451 E 12TH St
Oakland, CA 94601-3463

Mailing address

1623 Alcatraz St
Unit F
Berkley, CA 94703

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024003684 CA Practitioner - Registered Dietitian Or Nutrition Professional 0345773644 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Clinica de la Raza IncGroup PAC ID 1557258282, 130 clinicians

Practice addresses (Care Compare)

1501 Fruitvale Ave
Oakland, CA 94601-2322
Phone (510) 535-6200

1515 Fruitvale Ave
Oakland, CA 94601-2322
Phone (510) 535-6300

1515 Fruitvale Ave
Oakland, CA 94601-2355

3050 E 16TH St
Oakland, CA 94601-2319
Phone (510) 535-4700

3060 E 9TH St
Suite B
Oakland, CA 94601-2925
Phone (510) 535-4141

3451 E 12TH St
Oakland, CA 94601-3463
Phone (510) 535-3500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
86372091CAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
La Clinica de la Raza Inc Current Accepting new patients
La Clinica de la Raza Inc CurrentSince Oct 1, 2024 Accepting new patients
La Clinica de la Raza Inc CurrentSince Oct 1, 2024 Accepting new patients
La Clinica de la Raza, Inc. Past Accepting new patients

Locations

3451 E 12th St
Fl 3
Oakland, CA 94601
Phone (510) 535-3710

3451 E 12th St
Fl 2
Oakland, CA 94601
Phone (510) 535-3319

3451 E 12th St
Oakland, CA 94601
Phone (510) 535-3319

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1215756820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1623 ALCATRAZ ST",
            "address_2": "UNIT F",
            "city": "BERKLEY",
            "state": "CA",
            "postal_code": "94703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3451 E 12TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946013463",
            "telephone_number": "510-535-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMASCO",
        "first_name": "GENEVIVE",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-09",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86372091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.