Provider Demographics
NPI:1740579523
Name:FORBES, JUSTINE STROLIS (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:STROLIS
Last Name:FORBES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CARLTON AVENUE
Mailing Address - Street 2:#5
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2629
Mailing Address - Country:US
Mailing Address - Phone:408-354-5775
Mailing Address - Fax:408-402-5920
Practice Address - Street 1:400 CARLTON AVENUE
Practice Address - Street 2:#5
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2629
Practice Address - Country:US
Practice Address - Phone:408-354-5775
Practice Address - Fax:408-402-5920
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA184112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7116730Medicaid
CAA21313Medicare UPIN
CA00A184110Medicare PIN