Healthcare Provider Details

I. General information

NPI: 1497610307
Provider Name (Legal Business Name): FAYTH LEANNE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAYA LEANNE FORD

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 N FRESNO ST STE 102
FRESNO CA
93710-5280
US

IV. Provider business mailing address

12129 ROAD 36
MADERA CA
93636-8582
US

V. Phone/Fax

Practice location:
  • Phone: 559-224-9078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: