MEDICARE: CHRISTINA M FORD, MD

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
1	2084P0800X	Psychiatry Physician	A111264	CA

General Provider Information

NPI Number	:	1366700924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINA M FORD, MD

Provider Business Mailing Address
First Line	:	11777 SAN VICENTE BLVD
Second Line	:	#703
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5011
Country	:	US
Telephone Number	:	310-795-7921
Fax Number	:

Provider Business Practice Location Address
First Line	:	11777 SAN VICENTE BLVD
Second Line	:	#703
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5011
Country	:	US
Telephone Number	:	310-795-7921
Fax Number	:	310-826-7780

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CHRISTINA M FORD
Credential	:	M. D.
Telephone Number	:	310-795-7921

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	05/01/2012

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