MEDICARE: KENDALL DEMEIRE HITCHCOCK

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1841927613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL DEMEIRE HITCHCOCK

Provider Business Mailing Address
First Line	:	1774 ZONAL AVE BLDG B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1064
Country	:	US
Telephone Number	:	310-221-6336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1774 ZONAL AVE BLDG B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1064
Country	:	US
Telephone Number	:	310-221-6336
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	06/12/2026

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