Healthcare Provider Details

I. General information

NPI: 1649529033
Provider Name (Legal Business Name): MARIO CORPUZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 07/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 WASHINGTON ST
ABINGTON MA
02351
US

IV. Provider business mailing address

536 WASHINGTON STREET
ABINGTON MA
02351
US

V. Phone/Fax

Practice location:
  • Phone: 781-871-3773
  • Fax:
Mailing address:
  • Phone: 781-871-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number259608
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN259608
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: