Provider Demographics
NPI:1013093103
Name:FORBES, LAJEAN AVON (CNM)
Entity type:Individual
Prefix:
First Name:LAJEAN
Middle Name:AVON
Last Name:FORBES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 VALLEY FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2777
Mailing Address - Country:US
Mailing Address - Phone:909-794-3411
Mailing Address - Fax:
Practice Address - Street 1:12712 HEACOCK ST
Practice Address - Street 2:SUITE 7
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3037
Practice Address - Country:US
Practice Address - Phone:951-924-6824
Practice Address - Fax:951-601-9302
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNM 1458363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology