Healthcare Provider Details

I. General information

NPI: 1255873642
Provider Name (Legal Business Name): PURE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 NE 167TH ST SUITE 1125
NORTH MIAMI BEACH FL
33162-2442
US

IV. Provider business mailing address

633 NE 167TH ST SUITE 1125
NORTH MIAMI BEACH FL
33162-2442
US

V. Phone/Fax

Practice location:
  • Phone: 305-705-4375
  • Fax:
Mailing address:
  • Phone: 305-705-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number133840021301
License Number StateFL

VIII. Authorized Official

Name: MARIO ORDUZ
Title or Position: OWNER
Credential: OWNER
Phone: 305-297-8583