Provider Demographics
NPI:1366598427
Name:SALAMA, MEDHAT SADIEK (MD)
Entity type:Individual
Prefix:
First Name:MEDHAT
Middle Name:SADIEK
Last Name:SALAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 HESPERIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5873
Mailing Address - Country:US
Mailing Address - Phone:760-241-6666
Mailing Address - Fax:760-244-3546
Practice Address - Street 1:12550 HESPERIA RD STE 100
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5873
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:760-244-3546
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine