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General NPI Number Information
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NPI Number | 1871861500
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Entity Type | Organization
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Legal Business Name | PHILIP ENTE MD INC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 1111 E OCEAN AVE
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City | LOMPOC
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State | CA
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Zip | 93436-7076
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Country | US
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Telephone | 805-735-7623
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Fax | 805-735-7224
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Provider Business Mailing Address
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Address Line | 1111 E. OCEAN AVENUE
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City | LOMPOC
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State | CA
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Zip | 93436
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Country | US
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Telephone | 805-735-7623
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Fax | 805-735-7224
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP ENTE
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Credential | MD
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Telephone | 805-735-7623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A42029
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License Number State | CA
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