Provider Demographics
NPI:1467558684
Name:ALLEN M.ENTIN, M.D. AND FELICIA A.OTA, M.D., INC
Entity Type:Organization
Organization Name:ALLEN M.ENTIN, M.D. AND FELICIA A.OTA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-1090
Mailing Address - Street 1:18370 BURBANK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2804
Mailing Address - Country:US
Mailing Address - Phone:818-708-1090
Mailing Address - Fax:818-708-3238
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-708-1090
Practice Address - Fax:818-708-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32015207V00000X
CAA65703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91387Medicare UPIN
CAH31676Medicare UPIN
CAW15170Medicare PIN