Provider Demographics
NPI:1619409893
Name:HENDREN, GERALDINE
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:HENDREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:PAGOROGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14363 DITTMAR DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-1836
Mailing Address - Country:US
Mailing Address - Phone:209-276-5288
Mailing Address - Fax:
Practice Address - Street 1:3655 TORRANCE BLVD
Practice Address - Street 2:SUITE 349
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4810
Practice Address - Country:US
Practice Address - Phone:310-933-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician