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General NPI Number Information
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NPI Number | 1942029459
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Entity Type | Organization
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Legal Business Name | ITZA CORAZON COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 518 N CHELTON RD STE 210
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5256
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Country | US
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Telephone | 710-500-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 518 N CHELTON RD STE 210
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5256
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Country | US
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Telephone | 719-500-6009
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PEDRO F RIDDELL
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Credential | SWC, LACC
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Telephone | 530-786-9882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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