Provider Demographics
NPI:1518359850
Name:ENT GROUP OF LOS ANGELES
Entity Type:Organization
Organization Name:ENT GROUP OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-609-0600
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-609-0600
Mailing Address - Fax:818-609-1680
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-609-0600
Practice Address - Fax:818-609-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty