Basic Information
| Provider Information | |||||||||
| NPI: | 1295847358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORNES | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4536 NIDO LN | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921173742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582700316 | ||||||||
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| Practice Location | |||||||||
| Address1: | DEPT. VETERENS AFFAIRS SAN DIEGO HEALTHCARE SERVICES | ||||||||
| Address2: | 3350 LA JOLLA VILLAGE DR. DEPT. PM&R MB 117 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585527487 | ||||||||
| FaxNumber: | 8585527452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8119 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.