Provider Demographics
NPI:1063446755
Name:HEALING EARTH & REJUVENATION
Entity Type:Organization
Organization Name:HEALING EARTH & REJUVENATION
Other - Org Name:ILUMA CENTER FOR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:ASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-792-0007
Mailing Address - Street 1:18205 BISCAYNE BLVD
Mailing Address - Street 2:#100
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2106
Mailing Address - Country:US
Mailing Address - Phone:305-792-0007
Mailing Address - Fax:305-792-0990
Practice Address - Street 1:18205 BISCAYNE BLVD
Practice Address - Street 2:#100
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2106
Practice Address - Country:US
Practice Address - Phone:305-792-0007
Practice Address - Fax:305-792-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIME86974207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty