Provider Demographics
NPI:1730426966
Name:STIDOLPH, KENDRA GAIL (HHP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:GAIL
Last Name:STIDOLPH
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1072
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-1072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 GRAND AVE
Practice Address - Street 2:STE C12
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1808
Practice Address - Country:US
Practice Address - Phone:760-275-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No374J00000XNursing Service Related ProvidersDoula