1992904064 NPI number — MARIA CLAIRE DEMOSTHENOUS D.O.

Table of content: MARIA CLAIRE DEMOSTHENOUS D.O. (NPI 1992904064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992904064 NPI number — MARIA CLAIRE DEMOSTHENOUS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMOSTHENOUS
Provider First Name:
MARIA
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992904064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2081 ARENA BLVD
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95834-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-285-8977
Provider Business Mailing Address Fax Number:
916-285-0338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BAYHILL DR
Provider Second Line Business Practice Location Address:
270
Provider Business Practice Location Address City Name:
SAN BRUNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94066-3062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-552-9652
Provider Business Practice Location Address Fax Number:
650-552-9348
Provider Enumeration Date:
07/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  20A10489 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: 036118786 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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