Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013331933 |
---|---|
Provider Name | Felicia Ford |
First Address | Inglewood, CA 90303-2548 |
Second Address | Los Angeles, CA 90057-4310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2014 |
Last Update Date | 12/02/2014 |