Provider Demographics
NPI:1376699256
Name:CORIZ, ROBERT BRIAN (BSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRIAN
Last Name:CORIZ
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PUEBLO OF SAN FELIPE
Mailing Address - Street 2:P.O. BOX 4350
Mailing Address - City:SAN FELIPE
Mailing Address - State:NM
Mailing Address - Zip Code:87001-4350
Mailing Address - Country:US
Mailing Address - Phone:505-867-9740
Mailing Address - Fax:505-867-6166
Practice Address - Street 1:PUEBLO OF SAN FELIPE
Practice Address - Street 2:5 COUGAR ROAD
Practice Address - City:SAN FELIPE
Practice Address - State:NM
Practice Address - Zip Code:87001-4350
Practice Address - Country:US
Practice Address - Phone:505-867-9740
Practice Address - Fax:505-867-6166
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker