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General NPI Number Information
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NPI Number | 1295298693
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Entity Type | Individual
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Provider Name | AUGUSTUS DEMANES
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Gender | Male
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 1000 W CARSON ST
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City | TORRANCE
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State | CA
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Zip | 90502-2004
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Country | US
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Telephone | 424-306-7874
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Fax |
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Provider Business Mailing Address
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Address Line | 607 AGNES DR
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City | WASHINGTON
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State | IL
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Zip | 61571-9410
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Country | US
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Telephone | 309-339-4712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A181936
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License Number State | CA
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