Provider Demographics
NPI:1528382884
Name:GIESE, JOEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:C
Last Name:GIESE
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 1:2073 VALLEY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1028
Mailing Address - Country:US
Mailing Address - Phone:619-562-6596
Mailing Address - Fax:
Practice Address - Street 1:2073 VALLEY LAKE DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1028
Practice Address - Country:US
Practice Address - Phone:619-562-6596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36920208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics