Basic Information
| Provider Information | |||||||||
| NPI: | 1144345810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTELLANO | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 E SPEEDWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857163917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208863432 | ||||||||
| FaxNumber: | 5208860169 | ||||||||
| Practice Location | |||||||||
| Address1: | 6567 E CARONDELET DR | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857106152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208863432 | ||||||||
| FaxNumber: | 5208860169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207UN0901X | 3950 | AZ | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | 3950 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 3950 | 01 | AZ | STATE LICENSE | OTHER | BC8450974 | 01 | AZ | DEA REGISTRATION | OTHER | 222863 | 05 | AZ | MEDICAID | P00958347 | 01 | AZ | RR MEDICARE | OTHER |