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Individual

WILLESHA MONIQUE 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
41175
CA

Other

Enumeration date
04/21/2022
Last updated
04/21/2022
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