Provider Demographics
NPI:1770645459
Name:DEMERJIAN, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DEMERJIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 E DYER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5600
Mailing Address - Country:US
Mailing Address - Phone:714-492-1011
Mailing Address - Fax:714-617-7639
Practice Address - Street 1:1221 E DYER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5600
Practice Address - Country:US
Practice Address - Phone:714-491-1011
Practice Address - Fax:714-617-7639
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20279103T00000X
CALCS137481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist