Provider Demographics
NPI:1548079247
Name:PINZON BURGOS, LUZ ADRIANA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:ADRIANA
Last Name:PINZON BURGOS
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 1:207 ZIRCON RD FL 34758
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-4377
Mailing Address - Country:US
Mailing Address - Phone:786-383-8012
Mailing Address - Fax:
Practice Address - Street 1:207 ZIRCON RD FL 34758
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-4377
Practice Address - Country:US
Practice Address - Phone:786-383-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-403904106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician