Provider Demographics
NPI:1043753361
Name:FORREST, DAVID (SOIDC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FORREST
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GARDENSIDE CT
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2367
Mailing Address - Country:US
Mailing Address - Phone:760-725-8912
Mailing Address - Fax:
Practice Address - Street 1:120 GARDENSIDE CT
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2367
Practice Address - Country:US
Practice Address - Phone:760-725-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-19
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman