Rene Venzon Ticsay, RT

Primary specialty

Radiography Radiologic TechnologistTaxonomy code 2471C3402X

License

271815 Issued in MN

Practice address

Kayenta Health Center Highway 160
Kayenta, AZ 86033

Phone

(928) 697-4306

Fax

(928) 697-4107

NPI assigned

Oct 21, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kayenta Health Center, Radiology Dept

  • Radiography Radiologic Technologist
  • Kayenta, AZ
  • NPI 1497205710
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477008000000",
    "number": "1184175432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15951 W COCOPAH ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853387930",
            "telephone_number": "928-697-4306",
            "fax_number": "928-697-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "KAYENTA HEALTH CENTER HIGHWAY 160",
            "city": "KAYENTA",
            "state": "AZ",
            "postal_code": "86033",
            "telephone_number": "928-697-4306",
            "fax_number": "928-697-4107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICSAY",
        "first_name": "RENE",
        "middle_name": "VENZON",
        "name_prefix": "Mr.",
        "credential": "RT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-21",
        "last_updated": "2016-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471C3402X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Radiography",
            "state": "AZ",
            "license": "14256",
            "primary": false
        },
        {
            "code": "2471C3402X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Radiography",
            "state": "MN",
            "license": "271815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Tarutani, O.D.
• Nuri Tawwab, PHARMD
• Lorraine Thomas, RN
• Roxanne Natalie Thomas
• Three Springs, LLC
• Freida Todecheene
• Ksenija Topic, D.P.M.
• TRC - Four Corners Dialysis Clinics LLC (Kayenta Dialysis)
• Jodawna Renee Tso, RN
• Dorothy Louise Turner, RN

• Radiography Radiologic Technologist in Kayenta, AZ
• Providers in Kayenta, AZ by specialty
• Radiography Radiologic Technologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.