Provider Demographics
NPI:1023288131
Name:FOREST ANESTHESIA MEDICAL GROUP INC
Entity type:Organization
Organization Name:FOREST ANESTHESIA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-354-9256
Mailing Address - Street 1:PO BOX 35695
Mailing Address - Street 2:
Mailing Address - City:MONTE SERENO
Mailing Address - State:CA
Mailing Address - Zip Code:95030-0695
Mailing Address - Country:US
Mailing Address - Phone:408-354-9256
Mailing Address - Fax:408-354-9257
Practice Address - Street 1:2110 FOREST AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1469
Practice Address - Country:US
Practice Address - Phone:408-354-9256
Practice Address - Fax:408-354-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty