Provider Demographics
NPI:1982036935
Name:FOREST CLINICA FAMILIAR LLC
Entity Type:Organization
Organization Name:FOREST CLINICA FAMILIAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-464-6256
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:
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:75243-6176
Practice Address - Country:US
Practice Address - Phone:469-464-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3024208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty