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General NPI Number Information
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NPI Number | 1538405766
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Entity Type | Organization
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Legal Business Name | VORTEIL DERMATOLOGY AND AESTHETIC SCIENCE, INC
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Dates
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Enumeration Date | 12/16/2012
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Last Update Date | 12/16/2012
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Provider Practice Location Address
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Address Line | 33971 SELVA RD SUITE 200
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City | DANA POINT
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State | CA
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Zip | 92629-3788
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Country | US
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Telephone | 949-276-2600
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Fax | 949-276-2601
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Provider Business Mailing Address
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Address Line | 33971 SELVA RD SUITE 200
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City | DANA POINT
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State | CA
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Zip | 92629-3788
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Country | US
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Telephone | 949-276-2600
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Fax | 949-276-2601
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Authorized Official
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Title or Position | CEO
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Name | DR. RYAN GOERIG
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Credential | MD
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Telephone | 949-276-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A113581
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License Number State | CA
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