MEDICARE: MICHAEL RAY DEMARCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist

General Provider Information

NPI Number	:	1205352929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RAY DEMARCO

Provider Business Mailing Address
First Line	:	13924 MARQUESAS WAY APT 2302
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10940 S PARKER RD # 503
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-7440
Country	:	US
Telephone Number	:	720-939-2431
Fax Number	:	303-922-4640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	08/15/2017

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