Provider Demographics
NPI:1073671814
Name:ENRILE, FERNANDO TIONGSON (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:TIONGSON
Last Name:ENRILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14540 VICTORY BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1600
Mailing Address - Country:US
Mailing Address - Phone:818-989-9700
Mailing Address - Fax:818-989-9705
Practice Address - Street 1:14540 VICTORY BLVD
Practice Address - Street 2:STE 100
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1600
Practice Address - Country:US
Practice Address - Phone:818-989-9700
Practice Address - Fax:818-989-9705
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA29539207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice