Healthcare Provider Details

I. General information

NPI: 1255196747
Provider Name (Legal Business Name): ENTICARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S LINDSAY RD STE 124
GILBERT AZ
85297-2100
US

IV. Provider business mailing address

2051 W CHANDLER BLVD STE 5
CHANDLER AZ
85224-6239
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-9000
  • Fax: 480-214-9999
Mailing address:
  • Phone: 480-214-9000
  • Fax: 480-214-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HOMAN MOSTAFAVI
Title or Position: MEMBER MANAGER
Credential:
Phone: 480-214-9000