Provider Demographics
NPI:1366474819
Name:ENTE, PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:ENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E OCEAN AVE
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7076
Mailing Address - Country:US
Mailing Address - Phone:805-735-7623
Mailing Address - Fax:805-735-7224
Practice Address - Street 1:1111 E OCEAN AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7076
Practice Address - Country:US
Practice Address - Phone:805-735-7623
Practice Address - Fax:805-735-7224
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA420292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420290Medicaid
CAWA42029AMedicare PIN
CAA85737Medicare UPIN
CAA42029Medicare ID - Type UnspecifiedPROVIDER NUMBER