Provider Demographics
NPI:1154501120
Name:FORQUER, BRIAN DURAND (MS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DURAND
Last Name:FORQUER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14435 SHERMAN WAY
Mailing Address - Street 2:#207
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2331
Mailing Address - Country:US
Mailing Address - Phone:818-994-8927
Mailing Address - Fax:
Practice Address - Street 1:14435 SHERMAN WAY
Practice Address - Street 2:#207
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2331
Practice Address - Country:US
Practice Address - Phone:818-994-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU482231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AUD482Medicare PIN