Organization
BIOLIBRIUMPLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ITCHAQUEIRA BEATRIZ FONTANEZ VENDRELL RD/LDN (OWNER, MANAGER, PROVIDER)
(863) 258-7986
Entity
Organization
Contact information
Practice address
1675 POLO LAKE DR E APT 104, WELLINGTON, FL 33414-3112
(863) 258-7986
Mailing address
1675 POLO LAKE DR E APT 104, WELLINGTON, FL 33414-3112
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15048304
CAQH
—
01
—
1629664685
NPPES
—
Enumeration date
01/03/2021
Last updated
01/03/2021
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