Provider Demographics
NPI:1386456382
Name:DEMARCO, REYNOLD JR
Entity type:Individual
Prefix:MR
First Name:REYNOLD
Middle Name:
Last Name:DEMARCO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 N MOLLISON AVE APT 74
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-6846
Mailing Address - Country:US
Mailing Address - Phone:619-328-8983
Mailing Address - Fax:
Practice Address - Street 1:233 N MOLLISON AVE APT 74
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-6846
Practice Address - Country:US
Practice Address - Phone:619-328-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center