Provider Demographics
NPI:1053408229
Name:SALVATORE, KATHLEEN ANN (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:SALVATORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8917
Mailing Address - Country:US
Mailing Address - Phone:956-412-2700
Mailing Address - Fax:956-412-2701
Practice Address - Street 1:1713 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8917
Practice Address - Country:US
Practice Address - Phone:956-412-2700
Practice Address - Fax:956-412-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ44962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129008207Medicaid
TXG14502Medicare UPIN
TX129008207Medicaid