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General NPI Number Information
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NPI Number | 1821319443
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Entity Type | Individual
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Provider Name | JOANNE CASTILLO RIVERA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 2722 E MICHIGAN AVE STE 209
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City | LANSING
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State | MI
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Zip | 48912-4005
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Country | US
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Telephone | 314-888-5233
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Fax | 203-590-8644
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Provider Business Mailing Address
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Address Line | 711 SILVERMINE RD
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City | NEW CANAAN
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State | CT
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Zip | 06840-4329
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Country | US
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Telephone | 314-888-5233
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Fax | 203-590-8644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MT197208
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD449325
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301116555
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License Number State | MI
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