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General NPI Number Information
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NPI Number | 1801974084
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Entity Type | Individual
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Provider Name | IMELDA DE FOREST M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 1700 N ROSE AVE STE 280
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City | OXNARD
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State | CA
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Zip | 93030-7645
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Country | US
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Telephone | 805-384-8071
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Fax | 805-981-6201
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Provider Business Mailing Address
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Address Line | 3400 DATA DR ATTN: CREDENTIALING/PAYER ENROLLMENT
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7956
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A51405
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License Number State | CA
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