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General NPI Number Information
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NPI Number | 1033295522
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Entity Type | Organization
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Legal Business Name | LIFE HEALTH CARE GROUP, INC.
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 14540 VICTORY BLVD STE 100
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City | VAN NUYS
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State | CA
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Zip | 91411-1600
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Country | US
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Telephone | 818-989-9700
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Fax | 818-989-9705
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Provider Business Mailing Address
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Address Line | 14540 VICTORY BLVD STE 100
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City | VAN NUYS
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State | CA
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Zip | 91411-1600
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Country | US
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Telephone | 818-989-9700
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Fax | 818-989-9705
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FERNANDO TIONGSON ENRILE
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Credential | M.D.
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Telephone | 818-989-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A29539
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A29539
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License Number State | CA
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