Provider Demographics
NPI:1841411311
Name:KENDRACARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:KENDRACARE MEDICAL GROUP, INC.
Other - Org Name:KARE MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:DELEECA
Authorized Official - Last Name:ARMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:760-243-7330
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-0791
Mailing Address - Country:US
Mailing Address - Phone:760-247-7330
Mailing Address - Fax:
Practice Address - Street 1:15080 7TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3865
Practice Address - Country:US
Practice Address - Phone:760-243-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty