Provider Demographics
NPI:1093151185
Name:THE GRACE OF THE DIVINE HEALING & WELLNESS CENTER
Entity Type:Organization
Organization Name:THE GRACE OF THE DIVINE HEALING & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-778-0764
Mailing Address - Street 1:4009 19TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1003
Mailing Address - Country:US
Mailing Address - Phone:806-778-0764
Mailing Address - Fax:
Practice Address - Street 1:4009 19TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1003
Practice Address - Country:US
Practice Address - Phone:806-778-0764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty