Provider Demographics
NPI:1851306542
Name:INOCENTES, FE A (MD)
Entity Type:Individual
Prefix:
First Name:FE
Middle Name:A
Last Name:INOCENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-0000
Mailing Address - Country:US
Mailing Address - Phone:310-326-8600
Mailing Address - Fax:310-326-8366
Practice Address - Street 1:2900 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-0000
Practice Address - Country:US
Practice Address - Phone:310-326-8600
Practice Address - Fax:310-326-8366
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A456640Medicaid
F16736Medicare UPIN
CAWA45664KMedicare ID - Type UnspecifiedMEDICARE PPIN