Provider Demographics
NPI:1114197142
Name:FORTMANN, DANIEL LINK (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LINK
Last Name:FORTMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32281 CAMINO CAPISTRANO
Mailing Address - Street 2:SUITE C-102
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3784
Mailing Address - Country:US
Mailing Address - Phone:949-493-7981
Mailing Address - Fax:949-493-0114
Practice Address - Street 1:32281 CAMINO CAPISTRANO
Practice Address - Street 2:SUITE C-102
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3784
Practice Address - Country:US
Practice Address - Phone:949-493-7981
Practice Address - Fax:949-493-0114
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37462207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A374620OtherMEDI-CAL
CA1114197142OtherNPI TYPE I
CA1881667400OtherNPI TYPE II
CAWA37462OOtherMEDICARE PPIN
CAW16456Medicare PIN
CA00A374620OtherMEDI-CAL