Provider Demographics
NPI:1801107420
Name:ANNETTE FORNOS MD PA
Entity type:Organization
Organization Name:ANNETTE FORNOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-266-7778
Mailing Address - Street 1:287 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-8010
Mailing Address - Country:US
Mailing Address - Phone:305-266-7778
Mailing Address - Fax:
Practice Address - Street 1:287 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-8010
Practice Address - Country:US
Practice Address - Phone:305-266-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102339174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty