Basic Information
| Provider Information | |||||||||
| NPI: | 1154953388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORBEY | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3216 FINCH DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951173512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086807098 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1171 HOMESTEAD RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950505485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083202590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2020 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
ID Information
| ID | Type | State | Issuer | Description | 10833696 | 01 | KAISER PERMANENTE | OTHER |