Provider Demographics
NPI:1063074755
Name:FORDE, HAILEY (PA-C)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:FORDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3833 WORSHAM AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1766
Mailing Address - Country:US
Mailing Address - Phone:562-595-5421
Mailing Address - Fax:562-426-2862
Practice Address - Street 1:3833 WORSHAM AVE STE 300
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1766
Practice Address - Country:US
Practice Address - Phone:562-595-5421
Practice Address - Fax:562-426-2862
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA56955363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant