Provider Demographics
NPI:1952094484
Name:BELLO CORZO, RANDY
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:BELLO CORZO
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 1:28501 SW 152ND AVE LOT 10
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1425
Mailing Address - Country:US
Mailing Address - Phone:786-674-6889
Mailing Address - Fax:
Practice Address - Street 1:12855 SW 132ND ST STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7221
Practice Address - Country:US
Practice Address - Phone:786-587-0424
Practice Address - Fax:786-250-5094
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-273561106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician