Individual
MISS AUTUMN LECI FORNASERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. PA-C
Contact information
Practice address
207 W LEGION RD, BRAWLEY, CA 92227-7780
(760) 351-3333
Mailing address
207 W LEGION RD, BRAWLEY, CA 92227-7780
(760) 351-3333
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21802
CA
Other
Enumeration date
09/19/2011
Last updated
12/06/2021
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