Provider Demographics
NPI:1710014410
Name:ENTICARE PC
Entity Type:Organization
Organization Name:ENTICARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTAFAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-214-9000
Mailing Address - Street 1:2051 W CHANDLER BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6239
Mailing Address - Country:US
Mailing Address - Phone:480-214-9000
Mailing Address - Fax:480-214-9999
Practice Address - Street 1:2051 W CHANDLER BLVD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6239
Practice Address - Country:US
Practice Address - Phone:480-214-9000
Practice Address - Fax:480-214-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4520207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4520OtherAZ LICENSE