Provider Demographics
NPI:1972364685
Name:HYDRATION SQUAD LLC
Entity type:Organization
Organization Name:HYDRATION SQUAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISGELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-810-3933
Mailing Address - Street 1:10743 NARCOOSSEE RD STE A12
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6946
Mailing Address - Country:US
Mailing Address - Phone:407-810-3933
Mailing Address - Fax:
Practice Address - Street 1:10743 NARCOOSSEE RD STE A12
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6946
Practice Address - Country:US
Practice Address - Phone:407-810-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty