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General NPI Number Information
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NPI Number | 1518303775
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Entity Type | Individual
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Provider Name | JOHN ANDREW HENDERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 1145 W REDONDO BEACH BLVD
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City | GARDENA
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State | CA
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Zip | 90247-3511
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Country | US
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Telephone | 310-532-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 650 CALIFORNIA AVE
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City | VENICE
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State | CA
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Zip | 90291-3440
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Country | US
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Telephone | 706-831-3693
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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 | A132202
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License Number State | CA
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