Provider Demographics
NPI:1104374263
Name:DEFOREST, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:DEFOREST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KELLER ST
Mailing Address - Street 2:A-7
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 KELLER ST
Practice Address - Street 2:A-7
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2349
Practice Address - Country:US
Practice Address - Phone:707-782-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath