Individual
FORREST LOGAN CARRUBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
45 WADSWORTH ST, HARTFORD, CT 06106-7108
(860) 527-1124
Mailing address
16 ESSEX ST APT F, HARTFORD, CT 06114-4039
(959) 777-0705
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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