Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 23806 | CA |
NPI | 1104189570 |
---|---|
Provider Name | Dr. Sepideh Forstie |
First Address | San Clemente, CA 92673-3021 |
Second Address | San Clemente, CA 92673-6315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 15/04/2016 |