Provider Demographics
NPI:1255084331
Name:HENDRICKS, VINCENTE SALVADOR (NONE)
Entity type:Individual
Prefix:MR
First Name:VINCENTE
Middle Name:SALVADOR
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:NONE
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20707 ANZA AVE APT 291
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2921
Mailing Address - Country:US
Mailing Address - Phone:361-759-3337
Mailing Address - Fax:
Practice Address - Street 1:713 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1612
Practice Address - Country:US
Practice Address - Phone:714-879-4274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst