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NPI Code Detail

MEDICARE: DESEREA L FORD

MEDICARE: DESEREA L FORD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1356787758
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESEREA L FORD
Provider Business Mailing Address
First Line : 600 N 1ST ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-1904
Country : US
Telephone Number : 702-463-0110
Fax Number : 702-463-0166
Provider Business Practice Location Address
First Line : 600 N 1ST ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-1904
Country : US
Telephone Number : 702-463-0110
Fax Number : 702-463-0166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2013
Last Update Date : 05/13/2013

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Directions to “ DESEREA L FORD ” Practice Location

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