Provider Demographics
NPI:1235353061
Name:FENDRICH, DOUGLAS JOEL (BC HIS)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JOEL
Last Name:FENDRICH
Suffix:
Gender:M
Credentials:BC HIS
Other - Prefix:MR
Other - First Name:DOUG
Other - Middle Name:
Other - Last Name:FENDRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13112 E HADLEY ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4583
Mailing Address - Country:US
Mailing Address - Phone:562-696-5054
Mailing Address - Fax:562-696-5054
Practice Address - Street 1:13112 E HADLEY ST
Practice Address - Street 2:SUITE 108
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4583
Practice Address - Country:US
Practice Address - Phone:562-696-5054
Practice Address - Fax:562-696-5054
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2291237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA2291OtherINSURANCE FORMS
CAHAOO22910Medicaid