1427455492 NPI number — NATHAN D. FORD MEDICAL CORPORATION Nathan D. Ford Medical Director

Table of content: Nathan D. Ford Medical Director (NPI 1427455492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427455492 NPI number — NATHAN D. FORD MEDICAL CORPORATION Nathan D. Ford Medical Director

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATHAN D. FORD MEDICAL CORPORATION
Provider Last Name:
Ford
Provider First Name:
Nathan
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Medical Director
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427455492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 N Roxbury Drive
Provider Second Line Business Mailing Address:
Suite 106
Provider Business Mailing Address City Name:
Beverly Hills
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
3107807136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 N Roxbury Drive
Provider Second Line Business Practice Location Address:
Suite 106
Provider Business Practice Location Address City Name:
Beverly Hills
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
3234308136
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ESCOBEDO
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
323-838-8075

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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