Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | G59705 | CA |
NPI | 1184892002 |
---|---|
Provider Name | L. Michael Kettel |
First Address | San Diego, CA 92130-3038 |
Second Address | San Diego, CA 92130-3038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2008 |
Last Update Date | 13/02/2008 |