Provider Demographics
NPI:1548234313
Name:ZALDIVAR, RENZO A (MD)
Entity Type:Individual
Prefix:
First Name:RENZO
Middle Name:A
Last Name:ZALDIVAR
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 1:3731 NW CARY PRKW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513
Mailing Address - Country:US
Mailing Address - Phone:919-443-2557
Mailing Address - Fax:919-443-2557
Practice Address - Street 1:3731 NW CARY PRKW
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513
Practice Address - Country:US
Practice Address - Phone:919-443-2557
Practice Address - Fax:919-869-1869
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00355207W00000X, 207WX0200X
FLME100129207WX0200X, 207W00000X
MN46912207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN450674000Medicaid
I11922Medicare UPIN
MN180001173Medicare ID - Type Unspecified
MNP00139421Medicare ID - Type UnspecifiedRAILROAD