Healthcare Provider Details

I. General information

NPI: 1134575509
Provider Name (Legal Business Name): COREBELLA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 HIGHLAND AVE STE 2
WATERBURY CT
06708-3454
US

IV. Provider business mailing address

417 HIGHLAND AVE STE 2
WATERBURY CT
06708-3454
US

V. Phone/Fax

Practice location:
  • Phone: 203-757-9336
  • Fax: 888-532-1877
Mailing address:
  • Phone: 203-757-9336
  • Fax: 888-532-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number6917
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCOS MALLI DE ESCOBAR
Title or Position: OWNER
Credential:
Phone: 203-757-9336