Organization
HANGOVER IV & BEAUTY THERAPY
Active
Parent organization
PURE IV THERAPY HEALTH & WELLNESS
Other names
PURE IV THERAPY HEALTH & WELLNESS
Organization subpart
Yes
Provider details
NPI number
Legal business name
PURE IV THERAPY HEALTH & WELLNESS
Authorized official
ANABEL GODINEZ (VICE PRESIDENT)
(561) 774-3443
Entity
Organization
Contact information
Practice address
4600 MILITARY TRL STE 110, JUPITER, FL 33458-4811
(561) 774-3443
(561) 630-6011
Mailing address
17977 KEYLIME BLVD, LOXAHATCHEE, FL 33470
(561) 774-3443
(561) 630-6011
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RI0001X
Clinical & Laboratory Immunology (Internal Medicine) Physician
—
—
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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