Healthcare Provider Details

I. General information

NPI: 1174585442
Provider Name (Legal Business Name): JOSIEPHINA CASTRO SOUZA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOSIEPHINA CASTRO SCHOENTHAL D.O.

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S.COAST GUARD ACADEMY MEDICAL 15 MOHEGAN AVE
NEW LONDON CT
06320
US

IV. Provider business mailing address

PO BOX 298
MYSTIC CT
06355-0298
US

V. Phone/Fax

Practice location:
  • Phone: 860-444-8276
  • Fax: 860-444-8413
Mailing address:
  • Phone: 860-444-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number20A6020
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: