MEDICARE: NARISSE KENDRICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G79000	CA

General Provider Information

NPI Number	:	1205893286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NARISSE KENDRICK M.D.

Provider Business Mailing Address
First Line	:	5570 SANCHEZ DR STE 110
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1119
Country	:	US
Telephone Number	:	408-356-8681
Fax Number	:	408-356-8684

Provider Business Practice Location Address
First Line	:	5570 SANCHEZ DR STE 110
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1119
Country	:	US
Telephone Number	:	408-356-8681
Fax Number	:	408-356-8684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/21/2022

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