Healthcare Provider Details

I. General information

NPI: 1760831317
Provider Name (Legal Business Name): DANIEL J. FORD SUDCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2016
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR BLDG F
MODESTO CA
95350-6131
US

IV. Provider business mailing address

3819 PRINCE ANDREW DR
RIVERBANK CA
95367-3094
US

V. Phone/Fax

Practice location:
  • Phone: 209-661-1596
  • Fax:
Mailing address:
  • Phone: 209-409-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: