Provider Demographics
NPI:1669584827
Name:FORNO, KARIN IDA (MD)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:IDA
Last Name:FORNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2930 2ND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-6244
Mailing Address - Country:US
Mailing Address - Phone:831-372-2273
Mailing Address - Fax:831-372-2295
Practice Address - Street 1:2930 2ND AVE STE 120
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6244
Practice Address - Country:US
Practice Address - Phone:831-372-2273
Practice Address - Fax:831-372-2295
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE82139Medicare UPIN