=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124906045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORA WELLNESS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2025
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5201 BLUE LAGOON DR STE 855
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-206-4588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5201 BLUE LAGOON DR STE 855
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-206-4588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MBR/OWNER
-----------------------------------------------------
Name | CLAUDIA P ESCOBAR
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 305-206-4588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------