Individual
CHERYL KETELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 SANTA ROSA ST, SAN LUIS OBISPO, CA 93405-1811
(805) 541-2650
(805) 541-4043
Mailing address
15 SANTA ROSA ST, SAN LUIS OBISPO, CA 93405-1811
(805) 541-2650
(805) 541-4043
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
53363
CA
Other
Enumeration date
04/29/2016
Last updated
04/20/2017
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