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General NPI Number Information
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NPI Number | 1033111380
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Entity Type | Individual
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Provider Name | KEVIN MARK DEITEL MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 2221 WANKEL WAY
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City | OXNARD
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State | CA
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Zip | 93030-0192
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Country | US
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Telephone | 805-988-9366
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Fax | 805-483-3747
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Provider Business Mailing Address
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Address Line | 1203 FLYNN RD UNIT 160
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City | CAMARILLO
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State | CA
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Zip | 93012-6203
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Country | US
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Telephone | 805-804-4168
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Fax | 805-830-1177
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | G85673
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License Number State | CA
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