Provider Demographics
NPI:1497031173
Name:FORD, STARCANIA DANIELLE
Entity Type:Individual
Prefix:
First Name:STARCANIA
Middle Name:DANIELLE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90714-1091
Mailing Address - Country:US
Mailing Address - Phone:424-236-8027
Mailing Address - Fax:424-236-8027
Practice Address - Street 1:5242 HAYTER AVE
Practice Address - Street 2:5
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2331
Practice Address - Country:US
Practice Address - Phone:424-236-8027
Practice Address - Fax:424-236-8027
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9771171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications