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General NPI Number Information
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NPI Number | 1710388103
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Entity Type | Organization
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Legal Business Name | CALIFORNIA VEIN VASCULAR AND DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 3200 INLAND EMPIRE BLVD STE 275
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City | ONTARIO
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State | CA
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Zip | 91764-5582
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Country | US
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Telephone | 626-623-6040
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Fax | 909-366-5940
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Provider Business Mailing Address
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Address Line | 3200 INLAND EMPIRE BLVD STE 275
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City | ONTARIO
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State | CA
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Zip | 91764-5582
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Country | US
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Telephone | 626-623-6040
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Fax | 909-366-5940
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Authorized Official
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Title or Position | PHYSICIAN
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Name | EDWIN NATHANIEL KENDRICK
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Credential | MD
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Telephone | 626-623-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C56176
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License Number State | CA
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