Provider Demographics
NPI:1134822695
Name:JOAQUIN, JOY CASTELO
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:CASTELO
Last Name:JOAQUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E SOUTH WATER ST APT 1514
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4127
Mailing Address - Country:US
Mailing Address - Phone:818-913-8884
Mailing Address - Fax:
Practice Address - Street 1:225 N COLUMBUS DR APT 3114
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5255
Practice Address - Country:US
Practice Address - Phone:818-913-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.082895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine