Organization
I-VITA HYDRATION AND WELLNESS LOUNGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MILTIYIA BLAIN BSN, RN (OWNER)
(321) 215-8304
Entity
Organization
Contact information
Practice address
425 BRECKENRIDGE CIR SE, PALM BAY, FL 32909-2341
(321) 215-8304
Mailing address
425 BRECKENRIDGE CIR SE, PALM BAY, FL 32909-2341
(321) 215-8304
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
06/21/2021
Last updated
07/02/2021
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