Provider Demographics
NPI:1720467756
Name:CORBIN, RONEL (DIPLOM, LAC)
Entity Type:Individual
Prefix:
First Name:RONEL
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:DIPLOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33168-4301
Mailing Address - Country:US
Mailing Address - Phone:305-562-7600
Mailing Address - Fax:
Practice Address - Street 1:10740 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33168-4301
Practice Address - Country:US
Practice Address - Phone:305-562-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3632171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist