Provider Demographics
NPI:1154149482
Name:FORSBERG, ALAYNA (NP)
Entity type:Individual
Prefix:MRS
First Name:ALAYNA
Middle Name:
Last Name:FORSBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALAYNA
Other - Middle Name:
Other - Last Name:MITTENESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3361 BUDD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5019
Mailing Address - Country:US
Mailing Address - Phone:952-454-1508
Mailing Address - Fax:
Practice Address - Street 1:1400 CAMINO DE LA REINA STE 107
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1512
Practice Address - Country:US
Practice Address - Phone:844-732-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner