Provider Demographics
NPI:1871861500
Name:PHILIP ENTE MD INC
Entity Type:Organization
Organization Name:PHILIP ENTE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-735-7623
Mailing Address - Street 1:1111 E. OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436
Mailing Address - Country:US
Mailing Address - Phone:805-735-7623
Mailing Address - Fax:805-735-7224
Practice Address - Street 1:1111 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7076
Practice Address - Country:US
Practice Address - Phone:805-735-7623
Practice Address - Fax:805-735-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42029261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIC85737Medicare UPIN