Provider Demographics
NPI: | 1376836510 |
---|---|
Name: | KENDRICK, JULIA (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JULIA |
Middle Name: | |
Last Name: | KENDRICK |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | JULIA |
Other - Middle Name: | |
Other - Last Name: | KENDRICK |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 15790 PAUL VEGA MD DR |
Mailing Address - Street 2: | |
Mailing Address - City: | HAMMOND |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70403-1436 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 985-230-1683 |
Mailing Address - Fax: | 985-230-6652 |
Practice Address - Street 1: | 15790 PAUL VEGA MD DR |
Practice Address - Street 2: | |
Practice Address - City: | HAMMOND |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70403-1436 |
Practice Address - Country: | US |
Practice Address - Phone: | 985-230-1683 |
Practice Address - Fax: | 985-230-6652 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-05-20 |
Last Update Date: | 2023-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 84071 | 207L00000X |
LA | 303689 | 207L00000X |
MA | 261386 | 207L00000X |
CA | 137230 | 208600000X |
MA | 253445 | 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
LA | 011992736 | Other | LA DL |