Provider Demographics
NPI:1538405766
Name:VORTEIL DERMATOLOGY AND AESTHETIC SCIENCE, INC
Entity type:Organization
Organization Name:VORTEIL DERMATOLOGY AND AESTHETIC SCIENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOERIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-276-2600
Mailing Address - Street 1:33971 SELVA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3788
Mailing Address - Country:US
Mailing Address - Phone:949-276-2600
Mailing Address - Fax:949-276-2601
Practice Address - Street 1:33971 SELVA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3788
Practice Address - Country:US
Practice Address - Phone:949-276-2600
Practice Address - Fax:949-276-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-16
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113581207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty