1346461522 NPI number — DR. VICTOR MCKENZIE FORD D.MIN, MFC

Table of content: DR. VICTOR MCKENZIE FORD D.MIN, MFC (NPI 1346461522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346461522 NPI number — DR. VICTOR MCKENZIE FORD D.MIN, MFC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
VICTOR
Provider Middle Name:
MCKENZIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.MIN, MFC
Provider Gender Code:
M

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:
1346461522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11665 AVENA PLACE
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92128-2484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-592-1476
Provider Business Mailing Address Fax Number:
858-673-4073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11665 AVENA PLACE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-592-1476
Provider Business Practice Location Address Fax Number:
858-673-4073
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  33843 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com