Provider Demographics
NPI:1891269239
Name:LQV LAUDERDALE BEACH LLC
Entity Type:Organization
Organization Name:LQV LAUDERDALE BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEJADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-579-4305
Mailing Address - Street 1:PO BOX 670902
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-0016
Mailing Address - Country:US
Mailing Address - Phone:954-579-4305
Mailing Address - Fax:209-830-4696
Practice Address - Street 1:3349 NE 33RD ST STE B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7111
Practice Address - Country:US
Practice Address - Phone:954-909-4998
Practice Address - Fax:209-830-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center