Provider Demographics
NPI:1114300118
Name:SUTHERLAND, KENDRA CHRISTINE
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:CHRISTINE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 CALLE LA RODA
Mailing Address - Street 2:APT. 226
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2774
Mailing Address - Country:US
Mailing Address - Phone:805-404-6923
Mailing Address - Fax:
Practice Address - Street 1:560 CALLE LA RODA
Practice Address - Street 2:APT. 226
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2774
Practice Address - Country:US
Practice Address - Phone:805-404-6923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program