Provider Demographics
NPI:1013989409
Name:SALAMATIN, MARIA D (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:SALAMATIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA DORIS
Other - Middle Name:ABUYUAN
Other - Last Name:STA.AGUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3003 HIGHWAY 95
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7802
Mailing Address - Country:US
Mailing Address - Phone:928-758-0202
Mailing Address - Fax:928-758-2656
Practice Address - Street 1:3003 HIGHWAY 95
Practice Address - Street 2:SUITE 101
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7802
Practice Address - Country:US
Practice Address - Phone:928-758-0202
Practice Address - Fax:928-758-2656
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ985187Medicaid
AZ106358Medicare ID - Type UnspecifiedMEDICARE
G99658Medicare UPIN