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NPI Code Detail

MEDICARE: MR. JAMES B ENTZ MFT

MEDICARE: MR. JAMES B ENTZ MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 31323CA

General Provider Information

NPI Number : 1013055441
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES B ENTZ MFT
Provider Business Mailing Address
First Line : 850 E FOOTHILL BLVD
Second Line :
City : RIALTO
State : CA
Zip : 92376-5230
Country : US
Telephone Number : 909-421-9495
Fax Number : 909-421-9494
Provider Business Practice Location Address
First Line : 18612 SANTA ANA AVE
Second Line :
City : BLOOMINGTON
State : CA
Zip : 92316-2636
Country : US
Telephone Number : 909-421-7120
Fax Number : 909-421-7128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 02/11/2022

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