MEDICARE: FORESTHILL MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A37917	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568410421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORESTHILL MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 1040
Second Line	:
City	:	FORESTHILL
State	:	CA
Zip	:	95631-1040
Country	:	US
Telephone Number	:	530-367-2229
Fax Number	:	530-367-4161

Provider Business Practice Location Address
First Line	:	23000 FORESTHILL RD
Second Line	:
City	:	FORESTHILL
State	:	CA
Zip	:	95631
Country	:	US
Telephone Number	:	530-367-2229
Fax Number	:	530-367-4161

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BLAISE PHILIP DESOUZA
Credential	:	MD
Telephone Number	:	530-367-2229

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/22/2020

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Directions to “FORESTHILL MEDICAL CENTER INC ” Practice Location

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