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NPI Code Detail

MEDICARE: DR. KEVIN MARK DEITEL MD

MEDICARE: DR. KEVIN MARK DEITEL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0117XOrthopaedic Surgery of the Spine PhysicianG85673CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G85673OTHERCAMEDICAL LICENSE
2H35473OTHERCAUPIN

General Provider Information

NPI Number : 1033111380
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN MARK DEITEL MD
Provider Business Mailing Address
First Line : 1203 FLYNN RD UNIT 160
Second Line :
City : CAMARILLO
State : CA
Zip : 93012-6203
Country : US
Telephone Number : 805-804-4168
Fax Number : 805-830-1177
Provider Business Practice Location Address
First Line : 2221 WANKEL WAY
Second Line :
City : OXNARD
State : CA
Zip : 93030-0192
Country : US
Telephone Number : 805-988-9366
Fax Number : 805-483-3747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/14/2025

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Directions to “ DR. KEVIN MARK DEITEL MD” Practice Location

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