Organization
LQV LAUDERDALE BEACH LLC
Active
Other names
Liquivida Lounge
Organization subpart
No
Provider details
NPI number
Authorized official
SAM TEJADA (OWNER)
(954) 579-4305
Entity
Organization
Contact information
Practice address
3349 NE 33RD ST STE B, FORT LAUDERDALE, FL 33308-7111
(954) 909-4998
(209) 830-4696
Mailing address
PO BOX 670902, CORAL SPRINGS, FL 33067-0016
(954) 579-4305
(209) 830-4696
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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