NPIMap

Organization Active NPI

LQV Lauderdale Beach LLC

  • Clinic/Center
  • Fort Lauderdale, FL
National Provider Identifier
1891269239
Registry record updated Jan 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
LQV LAUDERDALE BEACH LLC
Practice address
3349 NE 33Rd St Ste B
Fort Lauderdale, FL 33308-7111
Phone
(954) 909-4998
Fax
(209) 830-4696
NPI assigned
Jan 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sam Tejada
Title
Owner
Phone
(954) 579-4305

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3349 NE 33Rd St Ste B
Fort Lauderdale, FL 33308-7111

Mailing address

PO Box 670902
Coral Springs, FL 33067-0016
Phone (954) 579-4305

Other names 1

  • Liquivida Lounge Doing business as

National Provider Directory

National Provider Directory

Locations

3349 NE 33rd St
Ste B
Fort Lauderdale, FL 33308
Phone (954) 909-4998

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547769600000",
    "number": "1891269239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670902",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330670016",
            "telephone_number": "954-579-4305",
            "fax_number": "209-830-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3349 NE 33RD ST STE B",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333087111",
            "telephone_number": "954-909-4998",
            "fax_number": "209-830-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LQV LAUDERDALE BEACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-18",
        "last_updated": "2019-01-18",
        "status": "A",
        "authorized_official_last_name": "TEJADA",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-579-4305"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liquivida Lounge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.