MEDICARE: CORAZON INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	BH2129	AZ

General Provider Information

NPI Number	:	1841277969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAZON INC.

Provider Business Mailing Address
First Line	:	900 E. FLORENCE BLVD.
Second Line	:	STE G.
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-4666
Country	:	US
Telephone Number	:	520-836-4278
Fax Number	:	520-836-1786

Provider Business Practice Location Address
First Line	:	900 E FLORENCE BLVD STE G
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-4673
Country	:	US
Telephone Number	:	520-836-4278
Fax Number	:	520-836-1786

Authorized Official
Title or Position	:	CEO/CLINICAL DIRECTOR
Name	:	MRS. LETICIA MARTINEZ
Credential	:	LPC
Telephone Number	:	520-836-4278

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	11/04/2024

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