Provider Demographics
NPI:1144345810
Name:CASTELLANO, LISA M (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3501 E SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3917
Mailing Address - Country:US
Mailing Address - Phone:520-886-3432
Mailing Address - Fax:520-886-0169
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:SUITE 225
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6152
Practice Address - Country:US
Practice Address - Phone:520-886-3432
Practice Address - Fax:520-886-0169
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3950207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3950OtherSTATE LICENSE
AZ222863Medicaid
AZP00958347OtherRR MEDICARE
AZP00958347OtherRR MEDICARE
AZP00958347OtherRR MEDICARE
AZ116017Medicare PIN
AZ115613Medicare PIN