Provider Demographics
NPI:1871261248
Name:FORUM 7TO7 PLLC
Entity Type:Organization
Organization Name:FORUM 7TO7 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-495-2000
Mailing Address - Street 1:PO BOX 461649
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78246-1649
Mailing Address - Country:US
Mailing Address - Phone:210-495-2000
Mailing Address - Fax:210-495-2001
Practice Address - Street 1:14975 IH 35 N
Practice Address - Street 2:STE.105
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-3320
Practice Address - Country:US
Practice Address - Phone:210-495-2000
Practice Address - Fax:210-495-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental