Provider Demographics
NPI:1134575509
Name:COREBELLA HEALTH LLC
Entity type:Organization
Organization Name:COREBELLA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:MALLI
Authorized Official - Last Name:DE ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-757-9336
Mailing Address - Street 1:417 HIGHLAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3454
Mailing Address - Country:US
Mailing Address - Phone:203-757-9336
Mailing Address - Fax:888-532-1877
Practice Address - Street 1:417 HIGHLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3454
Practice Address - Country:US
Practice Address - Phone:203-757-9336
Practice Address - Fax:888-532-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
CT6917175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty