Individual
DR. CLINT KETCHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30195 FRASER DR, LAKE ELSINORE, CA 92530-7006
(951) 252-2720
(760) 414-3892
Mailing address
1000 VALE TERRACE DR, VISTA, CA 92084-5218
(760) 631-5000
(760) 414-3892
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301100963
MI
207Q00000X
Family Medicine Physician
Primary
A135564
CA
Other
Enumeration date
06/19/2012
Last updated
02/01/2019
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