Healthcare Provider Details

I. General information

NPI: 1225597537
Provider Name (Legal Business Name): VANESSA RENILDE FORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

2104 STARFIRE DR NE
ATLANTA GA
30345-3964
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-2000
  • Fax:
Mailing address:
  • Phone: 678-469-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number81341
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: