Provider Demographics
NPI:1336174002
Name:CATANZARO, ANTONINO (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONINO
Middle Name:
Last Name:CATANZARO
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 1:200 W ARBOR DR
Mailing Address - Street 2:MAIL CODE 8374
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9001
Mailing Address - Country:US
Mailing Address - Phone:619-543-5550
Mailing Address - Fax:619-543-3276
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MAIL CODE 8374
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-5550
Practice Address - Fax:619-543-3276
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19187207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G191870Medicaid
CAWG19187BMedicare ID - Type Unspecified
CA00G191870Medicaid
CAWG19187DMedicare ID - Type Unspecified