| Doctor Name: | DR. FERNANDO TIONGSON ENRILE |
| NPI Number: | 1073671814 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | A29539 |
| Business Practice Address: | 14540 Victory Blvd Ste 100 Van Nuys, CA - 914111600 |
| Business Phone Number: | 8189899700 |
| Business Fax Number: | 8189899705 |
| Mailing Address: | 14540 Victory Blvd, Ste 100 VAN NUYS |
| State: | CA |
| Postal Code: | 914111600 |
| Phone Number: | 8189899700 |
| Fax Number: | 8189899705 |
| NPI Enumeration Date: | 12/05/2006 |
| NPI Last Update Date: | 09/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A29539 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |