Provider Demographics
NPI:1881859981
Name:ENTABI, FATEH (MD)
Entity Type:Individual
Prefix:
First Name:FATEH
Middle Name:
Last Name:ENTABI
Suffix:
Gender:M
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:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-0906
Mailing Address - Country:US
Mailing Address - Phone:209-471-9325
Mailing Address - Fax:209-577-1509
Practice Address - Street 1:1070 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2251
Practice Address - Country:US
Practice Address - Phone:559-412-5533
Practice Address - Fax:559-412-5534
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124555208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery