Provider Demographics
NPI:1023382868
Name:JOHN R. TENCATI,M.D.,INC.
Entity Type:Organization
Organization Name:JOHN R. TENCATI,M.D.,INC.
Other - Org Name:JOHN R. TENCATI, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TENCATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-650-3090
Mailing Address - Street 1:320 SUPERIOR AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2778
Mailing Address - Country:US
Mailing Address - Phone:949-650-3090
Mailing Address - Fax:949-650-5723
Practice Address - Street 1:320 SUPERIOR AVE STE 270
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2778
Practice Address - Country:US
Practice Address - Phone:949-650-3090
Practice Address - Fax:949-650-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38287207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG38287OtherPTAN
CA1659458743OtherNPI
CAG38287OtherPTAN