Individual
TOM RYAN DEMEESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1510 SAN PABLO ST, SUITE 514, LOS ANGELES, CA 90033-5324
(323) 442-5910
(323) 442-6798
Mailing address
1510 SAN PABLO ST, SUITE 514, LOS ANGELES, CA 90033-5324
(323) 442-5910
(323) 442-6798
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C42820
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C428200
BLUE SHIELD PIN
CA
05
—
00C428200
—
CA
01
—
00C428200C29
CAL OPTIMA PIN
CA
01
—
020023696
MEDICARE RAILROAD PIN
CA
Enumeration date
07/05/2006
Last updated
10/13/2009
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