Provider Demographics
NPI:1427644376
Name:CORIZ, TENASHA (CCSS)
Entity type:Individual
Prefix:
First Name:TENASHA
Middle Name:
Last Name:CORIZ
Suffix:
Gender:F
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:TESUQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87574-0449
Mailing Address - Country:US
Mailing Address - Phone:505-983-6158
Mailing Address - Fax:
Practice Address - Street 1:816 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:PENA BLANCA
Practice Address - State:NM
Practice Address - Zip Code:87041-8750
Practice Address - Country:US
Practice Address - Phone:505-983-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist