Provider Demographics
NPI:1053350231
Name:SALAHUDDIN, ANN KELLEY
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:KELLEY
Last Name:SALAHUDDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:SCHRADER
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:
Practice Address - Street 1:168 N BRENT ST STE 302
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2840
Practice Address - Country:US
Practice Address - Phone:805-652-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58702207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G587020Medicaid
CA5628497OtherNCPDP/NPDS
830001988OtherRAILROAD MEDICARE
830001988OtherRAILROAD MEDICARE
CA00G587020Medicaid
WG58702BMedicare PIN