Provider Demographics
NPI:1992396634
Name:KISSEL, JOSHUA CRAIG
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CRAIG
Last Name:KISSEL
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:CAMP DEL MAR BUILDING 210735
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92058
Mailing Address - Country:US
Mailing Address - Phone:760-725-2142
Mailing Address - Fax:
Practice Address - Street 1:AREA 21 BUILDING 210735
Practice Address - Street 2:CAMP DEL MAR
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058
Practice Address - Country:US
Practice Address - Phone:760-725-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman