Organization
DANIEL L FORTMANN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA LUCILLE FORTMANN (CFO/ADMINISTRATOR)
(949) 233-0141
Entity
Organization
Contact information
Practice address
32281 CAMINO CAPISTRANO, STE C-102, SAN JUAN CAPISTRANO, CA 92675
(949) 493-7981
(949) 493-0114
Mailing address
32281 CAMINO CAPISTRANO, STE C-102, SAN JUAN CAPISTRANO, CA 92675
(949) 493-7981
(949) 493-0114
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A37462
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A374620
MEDI-CAL
CA
01
—
1114197142
NPI TYPE 1
—
01
—
1881667400
NPI TYPE II
CA
01
—
WA37462O
MEDICARE PPIN
CA
Enumeration date
02/13/2006
Last updated
07/21/2022
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