Provider Demographics
NPI:1437456647
Name:FORGETTE, KASHA MARIE (LAC, CMT)
Entity Type:Individual
Prefix:
First Name:KASHA
Middle Name:MARIE
Last Name:FORGETTE
Suffix:
Gender:F
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2920
Mailing Address - Country:US
Mailing Address - Phone:831-239-1948
Mailing Address - Fax:
Practice Address - Street 1:501 CEDAR ST
Practice Address - Street 2:SUIT B
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4358
Practice Address - Country:US
Practice Address - Phone:831-426-1093
Practice Address - Fax:831-426-6523
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13867171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist