Healthcare Provider Details

I. General information

NPI: 1124931936
Provider Name (Legal Business Name): KENDRA MOBLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 MAGNOLIA AVE APT 1
GARDENA CA
90247-4386
US

IV. Provider business mailing address

1103 MAGNOLIA AVE APT 1
GARDENA CA
90247-4386
US

V. Phone/Fax

Practice location:
  • Phone: 310-714-5902
  • Fax:
Mailing address:
  • Phone: 310-714-5902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: