Provider Demographics
NPI:1659399301
Name:DONALDSON-FORD, ROSEMARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:DONALDSON-FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17762 BEACH BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6860
Mailing Address - Country:US
Mailing Address - Phone:714-848-0080
Mailing Address - Fax:714-665-4679
Practice Address - Street 1:17762 BEACH BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6860
Practice Address - Country:US
Practice Address - Phone:714-848-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK107ZMedicare PIN