Healthcare Provider Details

I. General information

NPI: 1922775030
Provider Name (Legal Business Name): MICHAEL JOHN FORD MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16543 CARMENITA RD
CERRITOS CA
90703-2218
US

IV. Provider business mailing address

PO BOX 25033
SANTA ANA CA
92799-5033
US

V. Phone/Fax

Practice location:
  • Phone: 562-219-7251
  • Fax: 562-219-7252
Mailing address:
  • Phone: 714-347-1000
  • Fax: 714-647-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL FORD
Title or Position: PRESIDENT
Credential: MD
Phone: 310-938-4684