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General NPI Number Information
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NPI Number | 1083297071
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Entity Type | Organization
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Legal Business Name | LQV WEST PALM BEACH
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 1460 HIPPOCRATES WAY 2ND FLOOR
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City | WEST PALM
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State | FL
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Zip | 33411
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Country | US
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Telephone | 561-463-8227
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 HIPPOCRATES WAY 2ND FLOOR
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City | WEST PALM
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State | FL
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Zip | 33411
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CORPORATE DISTRICT MANAGER
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Name | BLAKE ENGLE
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Credential |
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Telephone | 954-650-2130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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