Healthcare Provider Details

I. General information

NPI: 1558207613
Provider Name (Legal Business Name): KENDRA GEBHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 25TH ST
SAN DIEGO CA
92102-2107
US

IV. Provider business mailing address

1315 25TH ST
SAN DIEGO CA
92102-2107
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-0067
  • Fax: 619-233-3990
Mailing address:
  • Phone: 619-233-0067
  • Fax: 619-233-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-KRMOCD
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: