Provider Information for 1598144685
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TENISHA DIANNE FORD
Sex: Female
NPI: 1598144685
Last Updated: 2024-10-15
Certification Date: 2024-05-14
Certification Date: 2024-05-14
Details
| Name | Value | ||||||||||||||||
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| NPI | 1598144685 | ||||||||||||||||
| Enumeration Date | 2015-05-22 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 14605 GRAHAM AVE VICTORVILLE, CA 92394-7004 United States Phone: 760-514-2889 | Fax:760-243-9559 | ||||||||||||||||
| Primary Practice Address | 14605 GRAHAM AVE VICTORVILLE, CA 92394-7004 United States Phone: 760-985-4308 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 14344 CAJON AVE STE 102 | ||||||||||||||||
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