Provider Demographics
NPI:1043766777
Name:RONEL CORBIN WELLNESS MEDICINE INCE
Entity Type:Organization
Organization Name:RONEL CORBIN WELLNESS MEDICINE INCE
Other - Org Name:HEALING ELEPHANT ACUPUNCTURE AND WELLNESS MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:305-562-7600
Mailing Address - Street 1:9526 NE 2ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138
Mailing Address - Country:US
Mailing Address - Phone:305-306-6566
Mailing Address - Fax:
Practice Address - Street 1:9526 NE 2ND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138
Practice Address - Country:US
Practice Address - Phone:305-306-6566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3632171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty