Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | DC14902 | CA |
NPI | 1447626890 |
---|---|
Provider Name | Dr. James Demarco |
First Address | Fountain Valley, CA 92708-3232 |
Second Address | Fountain Valley, CA 92708-3232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 19/08/2015 |