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General NPI Number Information
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NPI Number | 1265050264
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Entity Type | Organization
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Legal Business Name | PURIDIA LLC
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 2121 E FLAMINGO RD STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89119-5123
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Country | US
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Telephone | 808-312-8059
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 E FLAMINGO RD STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89119-5123
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Country | US
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Telephone | 808-312-8059
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CFO
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Name | ADAM BAGLEY
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Credential |
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Telephone | 808-312-8059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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