Healthcare Provider Details

I. General information

NPI: 1063692366
Provider Name (Legal Business Name): KENDRA HIGGINS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR SUITE 103
FULLERTON CA
92831-3702
US

IV. Provider business mailing address

680 LANGSDORF DR SUITE 103
FULLERTON CA
92831-3702
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-0050
  • Fax: 714-879-0249
Mailing address:
  • Phone: 714-879-0050
  • Fax: 714-879-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: