Provider Demographics
NPI:1689833675
Name:DEMASI, MARIE A (PAC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:DEMASI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 28949
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-8924
Mailing Address - Country:US
Mailing Address - Phone:559-258-4311
Mailing Address - Fax:559-224-9817
Practice Address - Street 1:40232 JUNCTION DRIVE
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644
Practice Address - Country:US
Practice Address - Phone:559-658-6420
Practice Address - Fax:559-658-6460
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA.19592363A00000X
CAPA 19592363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS15-01530OtherKS LICENSE
CAL618Medicaid
CAPA 19592OtherCA LICENSE
CACA133474Medicare UPIN