Basic Information
| Provider Information | |||||||||
| NPI: | 1174526677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATALDO | ||||||||
| FirstName: | RENZO | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 S THOMPSON ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860018759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282266400 | ||||||||
| FaxNumber: | 9282266411 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 S THOMPSON ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282266400 | ||||||||
| FaxNumber: | 9282266411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 05/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 29080 | AZ | N | Other Service Providers | Specialist | 207RC0001X | 29080 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 060066059 | 01 | AZ | MEDICARE RAILROAD | OTHER | 373390 | 05 | AZ | MEDICAID | AZ0885380 | 01 | AZ | BCBS AZ | OTHER |