Provider Demographics
NPI:1972512820
Name:DEMARCO, PAUL (NPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-5849
Mailing Address - Country:US
Mailing Address - Phone:626-408-5927
Mailing Address - Fax:626-358-0332
Practice Address - Street 1:4619 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1478
Practice Address - Country:US
Practice Address - Phone:626-286-1191
Practice Address - Fax:626-229-9867
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP14428363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q02954Medicare UPIN
CAHJ698ZMedicare PIN
CAWNP14428AMedicare ID - Type Unspecified