Provider Demographics
NPI:1164889036
Name:ENTABI MD INC
Entity Type:Organization
Organization Name:ENTABI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FATEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENTABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-412-5533
Mailing Address - Street 1:1070 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2251
Mailing Address - Country:US
Mailing Address - Phone:559-412-5533
Mailing Address - Fax:559-412-5534
Practice Address - Street 1:1070 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2251
Practice Address - Country:US
Practice Address - Phone:559-412-5533
Practice Address - Fax:559-412-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124555208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA107452Medicare PIN