=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366700924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINA M FORD, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2012
-----------------------------------------------------
Last Update Date | 05/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11777 SAN VICENTE BLVD #703
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90049-5011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-795-7921
-----------------------------------------------------
Fax | 310-826-7780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11777 SAN VICENTE BLVD #703
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90049-5011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-795-7921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. CHRISTINA M FORD
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 310-795-7921
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A111264
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------