Provider Demographics
NPI:1457025108
Name:FORD, CHONTECE MARIE
Entity Type:Individual
Prefix:
First Name:CHONTECE
Middle Name:MARIE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHONTECE
Other - Middle Name:MARIE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1065 A ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4122
Mailing Address - Country:US
Mailing Address - Phone:510-593-4729
Mailing Address - Fax:
Practice Address - Street 1:1065 A ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4122
Practice Address - Country:US
Practice Address - Phone:510-593-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist