=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265598510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERWIN C DEMIANY MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57463 29 PALMS HWY
-----------------------------------------------------
City | YUCCA VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92284-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-228-1856
-----------------------------------------------------
Fax | 760-228-1897
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57463 29 PALMS HWY
-----------------------------------------------------
City | YUCCA VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92284-2925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-228-1856
-----------------------------------------------------
Fax | 760-228-1897
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ERWIN C DEMIANY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 760-320-4710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A24077
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------