Provider Demographics
NPI:1629196969
Name:FORSHAN, COLLETTE L (HAD)
Entity Type:Individual
Prefix:MS
First Name:COLLETTE
Middle Name:L
Last Name:FORSHAN
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9912 CARMEL MOUNTAIN RD STE F
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2808
Mailing Address - Country:US
Mailing Address - Phone:858-240-7849
Mailing Address - Fax:858-240-7912
Practice Address - Street 1:9912 CARMEL MOUNTAIN RD STE F
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2808
Practice Address - Country:US
Practice Address - Phone:858-240-7849
Practice Address - Fax:858-240-7912
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7052237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629196969Medicaid