Provider Demographics
NPI:1831385087
Name:HENDRICKS, JAMES (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 ALAMEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2012
Mailing Address - Country:US
Mailing Address - Phone:619-777-3990
Mailing Address - Fax:
Practice Address - Street 1:NMCSD BLD #6
Practice Address - Street 2:34800 BOB WILSON DR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134
Practice Address - Country:US
Practice Address - Phone:619-777-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102049991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine