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General NPI Number Information
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NPI Number | 1134991177
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Entity Type | Organization
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Legal Business Name | LIVING WATER WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 2400 E COMMERCIAL BLVD STE 218
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4022
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Country | US
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Telephone | 305-334-6163
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Fax | 786-513-3811
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Provider Business Mailing Address
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Address Line | 13762 W STATE ROAD 84 # 95
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City | DAVIE
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State | FL
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Zip | 33325-5305
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Country | US
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Telephone | 305-334-6163
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Fax | 786-513-3811
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Authorized Official
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Title or Position | PROVIDER MANAGER
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Name | ALEJANDRO PEREZ
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Credential | APRN
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Telephone | 305-905-3042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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