Provider Demographics
NPI:1811441454
Name:FORBANG, LYDIA (R N)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:FORBANG
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 EDINGER AVE
Mailing Address - Street 2:724
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3242
Mailing Address - Country:US
Mailing Address - Phone:720-329-8902
Mailing Address - Fax:
Practice Address - Street 1:6100 EDINGER AVE
Practice Address - Street 2:724
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3242
Practice Address - Country:US
Practice Address - Phone:720-329-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95054211163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse