=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023382868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN R. TENCATI,M.D.,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2012
-----------------------------------------------------
Last Update Date | 02/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 SUPERIOR AVE STE 270
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-2778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-650-3090
-----------------------------------------------------
Fax | 949-650-5723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 SUPERIOR AVE STE 270
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-2778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-650-3090
-----------------------------------------------------
Fax | 949-650-5723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. JOHN ROBERT TENCATI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-650-3090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | G38287
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G38287
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------