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General NPI Number Information
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NPI Number | 1881667400
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Entity Type | Organization
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Legal Business Name | DANIEL L FORTMANN MD PC
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 32281 CAMINO CAPISTRANO STE C-102
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675
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Country | US
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Telephone | 949-493-7981
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Fax | 949-493-0114
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Provider Business Mailing Address
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Address Line | 32281 CAMINO CAPISTRANO STE C-102
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675
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Country | US
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Telephone | 949-493-7981
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Fax | 949-493-0114
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Authorized Official
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Title or Position | CFO/ADMINISTRATOR
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Name | MRS. CYNTHIA LUCILLE FORTMANN
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Credential |
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Telephone | 949-233-0141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A37462
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License Number State | CA
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