Individual
DR. CORRINE ANN CLINE-FORTUNATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
223 MOUNT HERMON ROAD, SUITE B, SCOTTS VALLEY, CA 95066
(831) 430-9910
(831) 430-9914
Mailing address
223 MOUNT HERMON ROAD, SUITE B, SCOTTS VALLEY, CA 95066
(831) 430-9910
(831) 440-9914
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
41379
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1098
ANESTHESIA LICENSE
CA
Enumeration date
08/19/2006
Last updated
03/07/2023
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