Basic Information
| Provider Information | |||||||||
| NPI: | 1851665855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORZO | ||||||||
| FirstName: | NIKITSHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1620 N 48TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850087723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023252485 | ||||||||
| FaxNumber: | 6022252485 | ||||||||
| Practice Location | |||||||||
| Address1: | 1620 N 48TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850087723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023252485 | ||||||||
| FaxNumber: | 6022252485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2012 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-01-9483 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.