Erik Christian Ketelsen, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

4653 Dock Rd
BLDG 524
Port Hueneme, CA 93043-4321

Phone

(619) 534-7920

NPI assigned

Dec 1, 2009

Last updated

Dec 1, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259625600000",
    "number": "1093043051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 ALISO LN",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930013214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4653 DOCK RD",
            "address_2": "BLDG 524",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930434321",
            "telephone_number": "619-534-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETELSEN",
        "first_name": "ERIK",
        "middle_name": "CHRISTIAN",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-01",
        "last_updated": "2009-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Independent Duty Corpsman in Port Hueneme, CA
• Providers in Port Hueneme, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.