Provider Demographics
NPI:1891223145
Name:CORAL THERAPY GROUP INC.
Entity Type:Organization
Organization Name:CORAL THERAPY GROUP INC.
Other - Org Name:CORALTHERAPY GROUP INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-586-2088
Mailing Address - Street 1:1701 W FLAGLER ST STE 215
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2018
Mailing Address - Country:US
Mailing Address - Phone:305-586-2088
Mailing Address - Fax:786-953-5613
Practice Address - Street 1:1701 W FLAGLER ST STE 215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2018
Practice Address - Country:US
Practice Address - Phone:305-586-2088
Practice Address - Fax:786-953-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty