Provider Demographics
NPI:1477676047
Name:DEMERS, ARIANA MARIE (DO)
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:MARIE
Last Name:DEMERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13949 MONO WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-2807
Mailing Address - Country:US
Mailing Address - Phone:209-533-5371
Mailing Address - Fax:
Practice Address - Street 1:13949 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2807
Practice Address - Country:US
Practice Address - Phone:209-533-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015853207X00000X
NMA144208207XX0005X
CA20A10879207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A10879Medicaid
CAPTAN:CF797YMedicare UPIN