Provider Demographics
NPI:1699176792
Name:HENDRIX, ROMEL
Entity Type:Individual
Prefix:
First Name:ROMEL
Middle Name:
Last Name:HENDRIX
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 1:3654 PONDEROSA AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-3426
Mailing Address - Country:US
Mailing Address - Phone:909-822-8166
Mailing Address - Fax:
Practice Address - Street 1:3654 PONDEROSA AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-3426
Practice Address - Country:US
Practice Address - Phone:909-822-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1310047251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health