Healthcare Provider Details

I. General information

NPI: 1023382868
Provider Name (Legal Business Name): JOHN R. TENCATI,M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUPERIOR AVE STE 270
NEWPORT BEACH CA
92663-2778
US

IV. Provider business mailing address

320 SUPERIOR AVE STE 270
NEWPORT BEACH CA
92663-2778
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-3090
  • Fax: 949-650-5723
Mailing address:
  • Phone: 949-650-3090
  • Fax: 949-650-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG38287
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG38287
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN ROBERT TENCATI
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 949-650-3090