Provider Demographics
NPI:1518635978
Name:OSTERMANN, JESSE DANIEL (SOIDC)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:DANIEL
Last Name:OSTERMANN
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S HILL AVE
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4049
Mailing Address - Country:US
Mailing Address - Phone:630-745-7045
Mailing Address - Fax:
Practice Address - Street 1:BLDG 4101 1ST RECONNAISSANCE BAS
Practice Address - Street 2:41 AREA, LAS FLORES
Practice Address - City:CAMP PENDELTON
Practice Address - State:CA
Practice Address - Zip Code:92055-5584
Practice Address - Country:US
Practice Address - Phone:760-725-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman