Provider Demographics
NPI:1518541317
Name:VIGOA CORCHO, YUNIOR
Entity Type:Individual
Prefix:
First Name:YUNIOR
Middle Name:
Last Name:VIGOA CORCHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 PENNFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974
Mailing Address - Country:US
Mailing Address - Phone:239-362-6457
Mailing Address - Fax:
Practice Address - Street 1:382 PENNFIELD ST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974
Practice Address - Country:US
Practice Address - Phone:239-362-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-157570106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician