Provider Demographics
NPI:1174909956
Name:PENDROFF, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:PENDROFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E ARROW HWY STE 102
Mailing Address - Street 2:SUITE #6
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3319
Mailing Address - Country:US
Mailing Address - Phone:909-623-6651
Mailing Address - Fax:909-623-0455
Practice Address - Street 1:279 E ARROW HWY STE 102
Practice Address - Street 2:SUITE #6
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3319
Practice Address - Country:US
Practice Address - Phone:909-623-6651
Practice Address - Fax:909-623-0455
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator