Provider Demographics
NPI:1205893286
Name:KENDRICK, NARISSE (MD)
Entity type:Individual
Prefix:
First Name:NARISSE
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 SANCHEZ DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1119
Mailing Address - Country:US
Mailing Address - Phone:408-356-8681
Mailing Address - Fax:408-356-8684
Practice Address - Street 1:5570 SANCHEZ DR STE 110
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1119
Practice Address - Country:US
Practice Address - Phone:408-356-8681
Practice Address - Fax:408-356-8684
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG079000Medicare UPIN