Provider Demographics
NPI:1285105478
Name:CORAZON PROVIDER SERVICES, LLC.
Entity type:Organization
Organization Name:CORAZON PROVIDER SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-272-1971
Mailing Address - Street 1:109 N. INDIANA
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2634
Mailing Address - Country:US
Mailing Address - Phone:956-272-1971
Mailing Address - Fax:956-348-0888
Practice Address - Street 1:109 N. INDIANA
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2634
Practice Address - Country:US
Practice Address - Phone:956-272-1971
Practice Address - Fax:956-348-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty