MEDICARE: CYRIL F KELLETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G17806	CA

General Provider Information

NPI Number	:	1558383836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYRIL F KELLETT MD

Provider Business Mailing Address
First Line	:	3927 WARING RD
Second Line	:	SUITE A
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4458
Country	:	US
Telephone Number	:	760-758-1120
Fax Number	:	760-758-7752

Provider Business Practice Location Address
First Line	:	3927 WARING RD
Second Line	:	SUITE A
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4458
Country	:	US
Telephone Number	:	760-758-1120
Fax Number	:	760-758-7752

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/09/2007

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