Provider Demographics
NPI:1972522860
Name:KENDRICK, ELIZABETH A (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ STE 565
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1349
Practice Address - Country:US
Practice Address - Phone:310-206-7662
Practice Address - Fax:310-206-6307
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58777207R00000X, 207RN0300X, 207RN0300X
WAMD00031981207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00031981OtherSTATE MEDICAL LICENSE
CA00G587770OtherMEDICAL PPIN #
WAMD00031981OtherSTATE MEDICAL LICENSE
WAMD00031981OtherSTATE MEDICAL LICENSE