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Individual
RANDALL VINCENT RICKETTS
Active
Individual
RANDALL VINCENT RICKETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A4956
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00AX49560
MEDICAL
CA
Enumeration date
10/24/2006
Last updated
11/19/2018
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