Provider Demographics
NPI:1255500609
Name:TOSSETTI, JESSE JOHN
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:JOHN
Last Name:TOSSETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6591 49 PALMS AVE
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2931
Mailing Address - Country:US
Mailing Address - Phone:760-830-5735
Mailing Address - Fax:
Practice Address - Street 1:6591 49 PALMS AVE
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8263
Practice Address - Country:US
Practice Address - Phone:760-830-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman