| Living Water Wellness Center, Llc | |
|
2194 Highway A1a Ste 206 Indian Harbour Beach FL 32937-4931 | |
| (321) 448-2924 | |
| (321) 256-5283 |
| Full Name | Living Water Wellness Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2194 Highway A1a Ste 206, Indian Harbour Beach, Florida |
| Authorized Official Name and Position | Alejandro Perez (PROVIDER MANAGER) |
| Authorized Official Contact | 3059053042 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Water Wellness Center, Llc 274 E Eau Gallie Blvd # 306 Indian Harbour Beach FL 32937-4874 Ph: (321) 448-2924 | Living Water Wellness Center, Llc 2194 Highway A1a Ste 206 Indian Harbour Beach FL 32937-4931 Ph: (321) 448-2924 |
| NPI Number | 1134991177 |
|---|---|
| Provider Enumeration Date | 10/24/2023 |
| Last Update Date | 02/06/2024 |
| Medicare PECOS PAC ID | 3577901529 |
|---|---|
| Medicare Enrollment ID | O20240409004860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134991177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Alejandro Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407256480 PECOS PAC ID: 2668798943 Enrollment ID: I20150304000484 |
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