# HANGOVER IV & BEAUTY THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PURE IV THERAPY HEALTH & WELLNESS
- **Other names:** PURE IV THERAPY HEALTH & WELLNESS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043788425
- **Legal business name:** PURE IV THERAPY HEALTH & WELLNESS
- **Authorized official:** ANABEL GODINEZ (VICE PRESIDENT)
- **Authorized official phone:** (561) 774-3443

## Contact information

- **Practice address:** 4600 MILITARY TRL STE 110, JUPITER, FL 33458-4811
- **Practice address phone:** (561) 774-3443
- **Practice address fax:** (561) 630-6011
- **Mailing address:** 17977 KEYLIME BLVD, LOXAHATCHEE, FL 33470
- **Mailing address phone:** (561) 774-3443
- **Mailing address fax:** (561) 630-6011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207RI0001X | Clinical & Laboratory Immunology (Internal Medicine) Physician | — | NULL | — |
| 207RI0001X | Clinical & Laboratory Immunology (Internal Medicine) Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/05/2018
- **Last updated:** 11/05/2018