Provider Demographics
NPI:1629509336
Name:SATTERFIELD, KELLIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:R
Last Name:SATTERFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4904
Mailing Address - Country:US
Mailing Address - Phone:800-345-8979
Mailing Address - Fax:909-949-3967
Practice Address - Street 1:5330 CARROLL CANYON RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3758
Practice Address - Country:US
Practice Address - Phone:800-765-2737
Practice Address - Fax:619-291-6577
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA187209207W00000X
WAMD61156469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1629509336Medicaid