Provider Demographics
NPI:1720002579
Name:REZENDES, CATHERINE M (DPM)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:REZENDES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12413 JUDSON RD
Mailing Address - Street 2:STE.120
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3202
Mailing Address - Country:US
Mailing Address - Phone:210-655-9965
Mailing Address - Fax:210-655-9985
Practice Address - Street 1:12413 JUDSON RD
Practice Address - Street 2:STE.120
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3202
Practice Address - Country:US
Practice Address - Phone:210-655-9965
Practice Address - Fax:210-655-9985
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1289213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1782880-01Medicaid
TX2596273OtherAETNA PROVIDER NUMBER
TX8F7030OtherBCBS PROVIDER NUMBER
TX2596273OtherAETNA PROVIDER NUMBER
TX8F7030OtherBCBS PROVIDER NUMBER