| Biolibriumpllc | |
|
1675 Polo Lake Dr E Apt 104 Wellington FL 33414-3112 | |
| (863) 258-7986 | |
| Not Available |
| Full Name | Biolibriumpllc |
|---|---|
| Speciality | Health Maintenance Organization |
| Location | 1675 Polo Lake Dr E Apt 104, Wellington, Florida |
| Authorized Official Name and Position | Itchaqueira Beatriz Fontanez Vendrell (OWNER, MANAGER, PROVIDER) |
| Authorized Official Contact | 8632587986 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Biolibriumpllc 1675 Polo Lake Dr E Apt 104 Wellington FL 33414-3112 Ph: () - | Biolibriumpllc 1675 Polo Lake Dr E Apt 104 Wellington FL 33414-3112 Ph: (863) 258-7986 |
| NPI Number | 1356939680 |
|---|---|
| Provider Enumeration Date | 01/03/2021 |
| Last Update Date | 01/03/2021 |
| Certification Date | 01/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356939680 | NPI | - | NPPES |
| 15048304 | Other | CAQH | |
| 1629664685 | Other | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 302R00000X | Health Maintenance Organization | (* (Not Available)) | Primary |
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