Basic Information
| Provider Information | |||||||||
| NPI: | 1083357842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENDRICK | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | CARSON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | R1444640921 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33119 JAMIESON ST | ||||||||
| Address2: | |||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925301529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512063110 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1370 S STATE ST STE A | ||||||||
| Address2: | |||||||||
| City: | SAN JACINTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925834922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517913330 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2022 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | Y |
No ID Information.