Provider Demographics
NPI:1902221666
Name:FOREST CLINICA FAMILIAR, LLC
Entity Type:Organization
Organization Name:FOREST CLINICA FAMILIAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-804-7929
Mailing Address - Street 1:9550 FOREST LN
Mailing Address - Street 2:SUITE 606
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5905
Mailing Address - Country:US
Mailing Address - Phone:469-804-7929
Mailing Address - Fax:469-804-7930
Practice Address - Street 1:9550 FOREST LN
Practice Address - Street 2:SUITE 606
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5905
Practice Address - Country:US
Practice Address - Phone:469-804-7929
Practice Address - Fax:469-804-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP7249142OtherDEA