Basic Information
| Provider Information | |||||||||
| NPI: | 1821187717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTELLUCCI | ||||||||
| FirstName: | ALFONSO | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15070 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852675070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022396968 | ||||||||
| FaxNumber: | 6022394144 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907121498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625312550 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20A14072 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DO3056 | NV | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.