Provider Demographics
NPI:1083357842
Name:KENDRICK, DON CARSON III (R1444640921)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:CARSON
Last Name:KENDRICK
Suffix:III
Gender:M
Credentials:R1444640921
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33119 JAMIESON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-1529
Mailing Address - Country:US
Mailing Address - Phone:951-206-3110
Mailing Address - Fax:
Practice Address - Street 1:40925 COUNTY CENTER DR STE 120
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6054
Practice Address - Country:US
Practice Address - Phone:951-600-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-ZGOYQE175T00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist