Healthcare Provider Details

I. General information

NPI: 1942954722
Provider Name (Legal Business Name): PURE CUT ESSENTIALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 NW 179TH TER
MIAMI GARDENS FL
33055-3137
US

IV. Provider business mailing address

5441 NW 179TH TER
MIAMI GARDENS FL
33055-3137
US

V. Phone/Fax

Practice location:
  • Phone: 954-629-1014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LARENNA BARIAS
Title or Position: DIRECTOR
Credential:
Phone: 954-629-1014