Provider Demographics
NPI:1174585442
Name:SOUZA, JOSIEPHINA CASTRO (DO)
Entity type:Individual
Prefix:DR
First Name:JOSIEPHINA
Middle Name:CASTRO
Last Name:SOUZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JOSIEPHINA
Other - Middle Name:CASTRO
Other - Last Name:SCHOENTHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-0298
Mailing Address - Country:US
Mailing Address - Phone:860-444-8276
Mailing Address - Fax:
Practice Address - Street 1:U.S.COAST GUARD ACADEMY MEDICAL
Practice Address - Street 2:15 MOHEGAN AVE
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-444-8276
Practice Address - Fax:860-444-8413
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6020171000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171000000XOther Service ProvidersMilitary Health Care Provider
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6020Medicare UPIN