Provider Demographics
NPI:1609934629
Name:KELL, DONNA LEE (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LEE
Last Name:KELL
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:PO BOX 25420
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-2277
Mailing Address - Country:US
Mailing Address - Phone:805-650-5910
Mailing Address - Fax:805-650-5972
Practice Address - Street 1:SANTA BARBARA COTTAGE HOSPITAL
Practice Address - Street 2:PUEBLO AT BATH
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93102
Practice Address - Country:US
Practice Address - Phone:805-569-7367
Practice Address - Fax:805-569-8354
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG762530207ZI0100X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G762530Medicaid
CA1356409379OtherGROUP NPI
CA220025810OtherRAILROAD MEDICARE
CAG762530OtherMEDICAL BOARD OF CA
CAZZZ42967ZOtherB;LUE SHIELD
CAG762530OtherMEDICAL BOARD OF CA
CA00G762530Medicaid
CAHW8260AMedicare PIN
G21758Medicare UPIN