Healthcare Provider Details

I. General information

NPI: 1457281214
Provider Name (Legal Business Name): FORWARD MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8757 BURTON WAY
WEST HOLLYWOOD CA
90048-3839
US

IV. Provider business mailing address

8757 BURTON WAY
WEST HOLLYWOOD CA
90048-3839
US

V. Phone/Fax

Practice location:
  • Phone: 385-455-7170
  • Fax: 888-823-5887
Mailing address:
  • Phone: 385-455-7170
  • Fax: 888-823-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SLACK
Title or Position: OWNER
Credential: DO
Phone: 385-455-7170