Provider Demographics
NPI:1801655055
Name:BOUZAS COSIO, LUIS ALBERTO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:BOUZAS COSIO
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 1:2435 VAN BUREN ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4953
Mailing Address - Country:US
Mailing Address - Phone:786-370-6851
Mailing Address - Fax:
Practice Address - Street 1:2435 VAN BUREN ST APT 2A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4953
Practice Address - Country:US
Practice Address - Phone:786-370-6851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician