Provider Demographics
NPI:1053134254
Name:POZO ACOSTA, HENRRY R
Entity type:Individual
Prefix:
First Name:HENRRY R
Middle Name:
Last Name:POZO ACOSTA
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 1:15306 SW 52ND LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4276
Mailing Address - Country:US
Mailing Address - Phone:786-294-4290
Mailing Address - Fax:
Practice Address - Street 1:15306 SW 52ND LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4276
Practice Address - Country:US
Practice Address - Phone:786-294-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician