1174585442 NPI number — DR. JOSIEPHINA CASTRO SOUZA D.O.

Table of content: DR. JOSIEPHINA CASTRO SOUZA D.O. (NPI 1174585442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174585442 NPI number — DR. JOSIEPHINA CASTRO SOUZA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUZA
Provider First Name:
JOSIEPHINA
Provider Middle Name:
CASTRO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHOENTHAL
Provider Other First Name:
JOSIEPHINA
Provider Other Middle Name:
CASTRO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174585442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYSTIC
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06355-0298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-444-8276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
U.S.COAST GUARD ACADEMY MEDICAL
Provider Second Line Business Practice Location Address:
15 MOHEGAN AVE
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-444-8276
Provider Business Practice Location Address Fax Number:
860-444-8413
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171000000X , with the licence number:  20A6020 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: 20A6020 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com