=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720941453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPITAL CLINCIA DEL MAR INTERNATIONAL BILLING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVENIDA REVOLUCION, LOPEZ MATEOS
-----------------------------------------------------
City | MAZATLAN
-----------------------------------------------------
State | SINALOA
-----------------------------------------------------
Zip | 81240
-----------------------------------------------------
Country | MX
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19300 RINALDI ST UNIT 8392
-----------------------------------------------------
City | PORTER RANCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91327-8870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-608-0596
-----------------------------------------------------
Fax | 609-710-5338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOMARIE DEMARCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-608-0596
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------