Provider Demographics
NPI:1790998342
Name:FOREMAN, CAROL (MA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 CASS ST
Mailing Address - Street 2:#503
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2037
Mailing Address - Country:US
Mailing Address - Phone:858-581-3934
Mailing Address - Fax:858-456-4230
Practice Address - Street 1:849 COAST BLVD
Practice Address - Street 2:#3
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4223
Practice Address - Country:US
Practice Address - Phone:858-456-4230
Practice Address - Fax:858-456-4181
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2924237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist