Provider Demographics
NPI:1518083195
Name:SALTZ, RENATO (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:
Last Name:SALTZ
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 1:5445 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7629
Mailing Address - Country:US
Mailing Address - Phone:801-274-9500
Mailing Address - Fax:801-274-9515
Practice Address - Street 1:5445 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-7629
Practice Address - Country:US
Practice Address - Phone:801-274-9500
Practice Address - Fax:801-274-9515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275274-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE14409Medicare UPIN