Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Miss. Autumn Leci Fornasero, MSPA-C

Individual provider Medical Physician Assistant · NPI 1124300959

Miss. Autumn Leci Fornasero, MSPA-C is a Physician Assistant in Brawley, California. Qualified in 2011, 15 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
15
Licensed in
CA
In the registry since
2011
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Practice location Address checks out

207 W Legion Rd
Brawley, CA 92227-7780
Phone: (760) 351-3333
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA21802 (CA)

Record details

NPI number1124300959
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSPA-C
Sole proprietorNo
NPI enumeratedSeptember 19, 2011
Last updated in NPPESDecember 6, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Brawley