Provider Demographics
NPI:1679020788
Name:WEST PALMDALE HEALTH CARE
Entity Type:Organization
Organization Name:WEST PALMDALE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ENTABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-274-9900
Mailing Address - Street 1:38925 TRADE CENTER DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3653
Mailing Address - Country:US
Mailing Address - Phone:661-274-9900
Mailing Address - Fax:
Practice Address - Street 1:38925 TRADE CENTER DR
Practice Address - Street 2:SUITE H
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3655
Practice Address - Country:US
Practice Address - Phone:661-274-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94489207Q00000X
CAA89044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty