Individual
JAY A HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
729 SUNRISE AVE STE 602, ROSEVILLE, CA 95661-4542
(916) 953-7571
(916) 771-8515
Mailing address
2350 EAST BIDWELL ST, FOLSOM, CA 95630-3455
(916) 984-3899
(916) 984-6522
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
G83722
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G83722
LICENSE
CA
Enumeration date
05/17/2006
Last updated
12/12/2023
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