Provider Demographics
NPI:1366652786
Name:POKORNY, CORINNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:CORINNA
Middle Name:M
Last Name:POKORNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7928 SIERRA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1833
Mailing Address - Country:US
Mailing Address - Phone:909-271-2702
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1356
Practice Address - Country:US
Practice Address - Phone:909-887-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98455207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079700Medicaid
CA00A984550Medicare PIN
CAGR0079700Medicaid