Healthcare Provider Details

I. General information

NPI: 1659458743
Provider Name (Legal Business Name): JOHN ROBERT TENCATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

320 SUPERIOR AVE SUITE 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:
Title or Position:
Credential:
Phone: