Provider Demographics
NPI:1134991177
Name:LIVING WATER WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:LIVING WATER WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-905-3042
Mailing Address - Street 1:13762 W STATE ROAD 84 # 95
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-5305
Mailing Address - Country:US
Mailing Address - Phone:305-334-6163
Mailing Address - Fax:786-513-3811
Practice Address - Street 1:2400 E COMMERCIAL BLVD STE 218
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4022
Practice Address - Country:US
Practice Address - Phone:305-334-6163
Practice Address - Fax:786-513-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care