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NPI Code Detail

MEDICARE: DEERIKA JANAY FORD

MEDICARE: DEERIKA JANAY FORD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1336759240
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEERIKA JANAY FORD
Provider Business Mailing Address
First Line : 9340 E STOCKTON BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95624-1563
Country : US
Telephone Number : 916-809-0238
Fax Number :
Provider Business Practice Location Address
First Line : 9340 E STOCKTON BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95624-1563
Country : US
Telephone Number : 916-809-0238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2020
Last Update Date : 07/24/2024

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Directions to “ DEERIKA JANAY FORD ” Practice Location

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