Healthcare Provider Details

I. General information

NPI: 1609724962
Provider Name (Legal Business Name): COREN HOLISTIC SELF CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 N FEDERAL HWY STE 4010
BOCA RATON FL
33487-1680
US

IV. Provider business mailing address

8000 N FEDERAL HWY STE 4010
BOCA RATON FL
33487-1680
US

V. Phone/Fax

Practice location:
  • Phone: 954-605-2851
  • Fax:
Mailing address:
  • Phone: 954-605-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RENE ENRIQUE CAMACHO CORDOBA
Title or Position: MENTAL HEALTH COUNSELOR
Credential:
Phone: 954-605-2851