| Kelly E Fordyce Md A Medical Corporation | |
|
777 Corporate Dr Ste 140 Ladera Ranch CA 92694-2136 | |
| (949) 409-4868 | |
| (949) 409-4898 |
| Full Name | Kelly E Fordyce Md A Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 777 Corporate Dr Ste 140, Ladera Ranch, California |
| Authorized Official Name and Position | Kelly E Fordyce (OWNER) |
| Authorized Official Contact | 9495738335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly E Fordyce Md A Medical Corporation 777 Corporate Dr Ste 140 Ladera Ranch CA 92694-2136 Ph: (949) 409-4868 | Kelly E Fordyce Md A Medical Corporation 777 Corporate Dr Ste 140 Ladera Ranch CA 92694-2136 Ph: (949) 409-4868 |
| NPI Number | 1831772417 |
|---|---|
| Provider Enumeration Date | 05/03/2021 |
| Last Update Date | 06/01/2021 |
| Medicare PECOS PAC ID | 9638579360 |
|---|---|
| Medicare Enrollment ID | O20210616002638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831772417 | NPI | - | NPPES |
| 00A732940 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kelly Elizabeth Fordyce |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477531481 PECOS PAC ID: 6103729538 Enrollment ID: I20040131000290 |
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Borecky Health Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Corporate Dr Ste 260, Ladera Ranch, CA 92694 Phone: 909-255-1905 Fax: 909-265-9463 | |
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