Provider Demographics
NPI:1972196152
Name:KENDA, CARA STEPHANIE (NURSE LVN)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:STEPHANIE
Last Name:KENDA
Suffix:
Gender:F
Credentials:NURSE LVN
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:STEPHANIE
Other - Last Name:KENDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CARA KENDA LVN
Mailing Address - Street 1:20008 GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4810
Mailing Address - Country:US
Mailing Address - Phone:626-510-5335
Mailing Address - Fax:
Practice Address - Street 1:5235 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5709
Practice Address - Country:US
Practice Address - Phone:323-660-0900
Practice Address - Fax:323-660-0771
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002704429-0001-6261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone