Provider Demographics
NPI:1669881306
Name:CUBAS-FORSYTH, CAREN Y (NP)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:Y
Last Name:CUBAS-FORSYTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3612
Mailing Address - Country:US
Mailing Address - Phone:415-752-3187
Mailing Address - Fax:
Practice Address - Street 1:1600 HOLLOWAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1722
Practice Address - Country:US
Practice Address - Phone:415-338-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily