Provider Demographics
NPI:1366619900
Name:FERNANDO ENRILE MD INC
Entity type:Organization
Organization Name:FERNANDO ENRILE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENRILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-385-2400
Mailing Address - Street 1:2120 W 8TH ST
Mailing Address - Street 2:#330
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4019
Mailing Address - Country:US
Mailing Address - Phone:213-385-2400
Mailing Address - Fax:213-385-2403
Practice Address - Street 1:2120 W 8TH ST
Practice Address - Street 2:#330
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4019
Practice Address - Country:US
Practice Address - Phone:213-385-2400
Practice Address - Fax:213-385-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073671814Medicaid
CAAW786AMedicare PIN
CAA29539Medicare PIN