Individual
KENNETH WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
286 EUCLID AVE, SUITE 204, SAN DIEGO, CA 92114-3610
(619) 527-0051
(619) 527-0056
Mailing address
286 EUCLID AVE, SUITE 204, SAN DIEGO, CA 92114-3610
(619) 527-0051
(619) 527-0056
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
E3455
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E34550
—
CA
Enumeration date
12/10/2005
Last updated
11/23/2007
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