Basic Information
| Provider Information | |||||||||
| NPI: | 1689833675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMASI | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O BOX 28949 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937288924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592584311 | ||||||||
| FaxNumber: | 5592249817 | ||||||||
| Practice Location | |||||||||
| Address1: | 40232 JUNCTION DRIVE | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596586420 | ||||||||
| FaxNumber: | 5596586460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.19592 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | PA 19592 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 15-01530 | 01 | KS | KS LICENSE | OTHER | L618 | 05 | CA | MEDICAID | PA 19592 | 01 | CA | CA LICENSE | OTHER |