Provider Demographics
NPI:1619950870
Name:CATINGUB, EDGAR MELTIADES (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:MELTIADES
Last Name:CATINGUB
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:PO BOX 581596
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0027
Mailing Address - Country:US
Mailing Address - Phone:707-685-4473
Mailing Address - Fax:
Practice Address - Street 1:8001 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2329
Practice Address - Country:US
Practice Address - Phone:707-685-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0924932084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA092493Medicaid
CAA092493Medicaid