Provider Demographics
NPI:1134932163
Name:FORREST, JOSEPH ANDREW I (MPSS-EYDHQB)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANDREW
Last Name:FORREST
Suffix:I
Gender:M
Credentials:MPSS-EYDHQB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 MARKET ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-2225
Mailing Address - Country:US
Mailing Address - Phone:858-351-6000
Mailing Address - Fax:619-866-6245
Practice Address - Street 1:5101 MARKET ST STE 2300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-2225
Practice Address - Country:US
Practice Address - Phone:858-351-6000
Practice Address - Fax:619-866-6245
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-EYDHQB175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist