MEDICARE: IGNACIO DEMARCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1992245104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGNACIO DEMARCO

Provider Business Mailing Address
First Line	:	1627 SE 43RD ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7484
Country	:	US
Telephone Number	:	239-443-6328
Fax Number	:	407-960-3009

Provider Business Practice Location Address
First Line	:	1627 SE 43RD ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7484
Country	:	US
Telephone Number	:	239-443-6328
Fax Number	:	407-960-3009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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Directions to “ IGNACIO DEMARCO ” Practice Location

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