Provider Demographics
NPI:1730682709
Name:CORZO III, JACINTO TOMAS
Entity type:Individual
Prefix:
First Name:JACINTO
Middle Name:TOMAS
Last Name:CORZO III
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15860 SW 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1654
Mailing Address - Country:US
Mailing Address - Phone:305-753-0815
Mailing Address - Fax:
Practice Address - Street 1:15860 SW 102ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1654
Practice Address - Country:US
Practice Address - Phone:305-753-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician