Basic Information
| Provider Information | |||||||||
| NPI: | 1538375365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORREST | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | JOAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SWEENEY | ||||||||
| OtherFirstName: | BRENDA | ||||||||
| OtherMiddleName: | FORREST | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 900 GREENLEY RD | ||||||||
| Address2: | SUITE 922 | ||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095363738 | ||||||||
| FaxNumber: | 2095363562 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 GREENLEY RD | ||||||||
| Address2: | SUITE 922 | ||||||||
| City: | SONORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095363738 | ||||||||
| FaxNumber: | 2095363562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 09/30/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G87532 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.