Healthcare Provider Details

I. General information

NPI: 1821319443
Provider Name (Legal Business Name): JOANNE CASTILLO RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 E MICHIGAN AVE STE 209
LANSING MI
48912-4005
US

IV. Provider business mailing address

711 SILVERMINE RD
NEW CANAAN CT
06840-4329
US

V. Phone/Fax

Practice location:
  • Phone: 314-888-5233
  • Fax: 203-590-8644
Mailing address:
  • Phone: 314-888-5233
  • Fax: 203-590-8644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT197208
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD449325
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301116555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: