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General NPI Number Information
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NPI Number | 1467987156
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Entity Type | Individual
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Provider Name | KAYLA KENDRIC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 909-558-4085
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Fax |
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Provider Business Mailing Address
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Address Line | 909 E CAMELBACK RD 1110
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City | PHOENIX
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State | AZ
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Zip | 85014-3687
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Country | US
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Telephone | 619-504-6959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A158149
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License Number State | CA
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