1609934629 NPI number — DONNA LEE KELL MD

Table of content: DONNA LEE KELL MD (NPI 1609934629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609934629 NPI number — DONNA LEE KELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELL
Provider First Name:
DONNA
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609934629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93002-2277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-650-5910
Provider Business Mailing Address Fax Number:
805-650-5972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SANTA BARBARA COTTAGE HOSPITAL
Provider Second Line Business Practice Location Address:
PUEBLO AT BATH
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-569-7367
Provider Business Practice Location Address Fax Number:
805-569-8354
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZI0100X , with the licence number:  G762530 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: G762530 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G762530 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1356409379 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 220025810 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G762530 . This is a "MEDICAL BOARD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ42967Z . This is a "B;LUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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