MEDICARE: I-VITA HYDRATION AND WELLNESS LOUNGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1144899642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I-VITA HYDRATION AND WELLNESS LOUNGE LLC

Provider Business Mailing Address
First Line	:	425 BRECKENRIDGE CIR SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-2341
Country	:	US
Telephone Number	:	321-215-8304
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 BRECKENRIDGE CIR SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-2341
Country	:	US
Telephone Number	:	321-215-8304
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MILTIYIA BLAIN
Credential	:	BSN, RN
Telephone Number	:	321-215-8304

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	07/02/2021

Similar Medicare Providers

1659911790 — CLARA'S ANGELS
Practice Location Address:

425 BRECKENRIDGE CIR SE
PALM BAY, FL
32909-2341

Practice Phone: 321-215-8304
Practice Fax:

1700187358 — MRS. TARA STEGALL HOMEIER LCSW
Practice Location Address:

2341 S MILITARY TRL
WEST PALM BEACH, FL
33415-7543

Practice Phone: 561-202-4277
Practice Fax:

1952154056 — OCEANS HEALTHCARE
Practice Location Address:

1555 PALM BEACH LAKES BLVD STE 950
WEST PALM BEACH, FL
33401-2341

Practice Phone: 337-315-7927
Practice Fax:

1144704461 — VERNESSA MAE REED
Practice Location Address:

2341 BEAVER BAY CT
LAS VEGAS, NV
89156-1019

Practice Phone: 702-312-5722
Practice Fax:

1588287890 — LEYANIS GONZALEZ
Practice Location Address:

10200 NICARAGUA DR
CUTLER BAY, FL
33189-2341

Practice Phone: 786-302-2166
Practice Fax:

1598380594 — DIANIBEL PAZOS GALVEZ
Practice Location Address:

10210 NICARAGUA DR
CUTLER BAY, FL
33189-2341

Practice Phone: 786-327-8474
Practice Fax:

Directions to “I-VITA HYDRATION AND WELLNESS LOUNGE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.