Healthcare Provider Details

I. General information

NPI: 1669881306
Provider Name (Legal Business Name): CAREN Y. CUBAS-FORSYTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HOLLOWAY AVE
SAN FRANCISCO CA
94132-1722
US

IV. Provider business mailing address

651 11TH AVE
SAN FRANCISCO CA
94118-3612
US

V. Phone/Fax

Practice location:
  • Phone: 415-338-1258
  • Fax:
Mailing address:
  • Phone: 415-752-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: