Provider Demographics
NPI:1861276388
Name:CORZO MARTIN, PEDRO LUIS
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:LUIS
Last Name:CORZO MARTIN
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 1:11518 SW 238TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6283
Mailing Address - Country:US
Mailing Address - Phone:786-691-5727
Mailing Address - Fax:
Practice Address - Street 1:11518 SW 238TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6283
Practice Address - Country:US
Practice Address - Phone:786-691-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician