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General NPI Number Information
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NPI Number | 1992904064
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Entity Type | Individual
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Provider Name | MARIA CLAIRE DEMOSTHENOUS D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 1001 BAYHILL DR 270
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City | SAN BRUNO
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State | CA
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Zip | 94066-3062
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Country | US
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Telephone | 650-552-9652
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Fax | 650-552-9348
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Provider Business Mailing Address
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Address Line | 2081 ARENA BLVD SUITE 160
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City | SACRAMENTO
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State | CA
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Zip | 95834-2309
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Country | US
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Telephone | 916-285-8977
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Fax | 916-285-0338
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A10489
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036118786
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License Number State | IL
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