Individual
MARY FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2050 FAIRMONT DR, SAN LEANDRO, CA 94578-1001
(510) 483-3030
Mailing address
2050 FAIRMONT DR, SAN LEANDRO, CA 94578-1001
(510) 483-3030
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
35797
CA
Other
Enumeration date
05/02/2022
Last updated
05/02/2022
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