Healthcare Provider Details

I. General information

NPI: 1629512462
Provider Name (Legal Business Name): JOSHUA PANNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 W RAMSEY ST STE 3AND4
BANNING CA
92220-3700
US

IV. Provider business mailing address

2781 W RAMSEY ST STE 3AND4
BANNING CA
92220-3700
US

V. Phone/Fax

Practice location:
  • Phone: 951-417-6612
  • Fax:
Mailing address:
  • Phone: 951-417-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: