Healthcare Provider Details

I. General information

NPI: 1326660432
Provider Name (Legal Business Name): EVAN DEMARCO RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 38TH ST
SACRAMENTO CA
95816-6712
US

IV. Provider business mailing address

1524 38TH ST
SACRAMENTO CA
95816-6712
US

V. Phone/Fax

Practice location:
  • Phone: 720-331-1129
  • Fax:
Mailing address:
  • Phone: 720-331-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: