Basic Information
| Provider Information | |||||||||
| NPI: | 1689646812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTELLI | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 MINNEQUA AVE | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810043734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195640660 | ||||||||
| FaxNumber: | 7195640037 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 COURT ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195436755 | ||||||||
| FaxNumber: | 7195832236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD34780 | TN | Y | Other Service Providers | Specialist | 207V00000X | 47810 | CO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 69385874 | 05 | CO | MEDICAID |