Healthcare Provider Details

I. General information

NPI: 1144345810
Provider Name (Legal Business Name): LISA M CASTELLANO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6567 E CARONDELET DR SUITE 225
TUCSON AZ
85710-6152
US

IV. Provider business mailing address

3501 E SPEEDWAY BLVD
TUCSON AZ
85716-3917
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-3432
  • Fax: 520-886-0169
Mailing address:
  • Phone: 520-886-3432
  • Fax: 520-886-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number3950
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3950
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: