Provider Demographics
NPI:1164051157
Name:PERRINE, KENDALL (ND)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:PERRINE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32840 PACIFIC COAST HWY STE A
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3469
Mailing Address - Country:US
Mailing Address - Phone:805-270-5063
Mailing Address - Fax:
Practice Address - Street 1:32840 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3468
Practice Address - Country:US
Practice Address - Phone:805-270-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
CA1149175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist