Individual
KENDRIC DOMINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5447 W SUNSET HILL AVE, BATON ROUGE, LA 70805-3215
(318) 840-2574
Mailing address
5447 W. SUNSET HILL, BATON ROUGE, LA 70805
(318) 840-2574
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
LA
Enumeration date
02/09/2017
Last updated
02/09/2017
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