Provider Demographics
NPI:1376547216
Name:FORLANO, VIKI A (MD)
Entity Type:Individual
Prefix:
First Name:VIKI
Middle Name:A
Last Name:FORLANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22000
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-7200
Mailing Address - Country:US
Mailing Address - Phone:325-481-2197
Mailing Address - Fax:325-659-0180
Practice Address - Street 1:4235 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5653
Practice Address - Country:US
Practice Address - Phone:325-481-2197
Practice Address - Fax:325-659-0180
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133474005Medicaid
TXE86982Medicare UPIN
TX133474005Medicaid