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1548138951 NPI number — PURELIFE WELLNESS & MEDSPA LLC

NPI Number: 1548138951
Health Care Provider/Practitioner: PURELIFE WELLNESS & MEDSPA LLC

Information about “1548138951” NPI (PURELIFE WELLNESS & MEDSPA LLC) exists in 1548138951 in HTML format HTML  |  1548138951 in plain Text format TXT  |  1548138951 in PDF (Portable Document Format) PDF  |  1548138951 in an XML format XML  formats.

NPI Number : 1548138951 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548138951",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PURELIFE WELLNESS & MEDSPA LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "423 N WOOD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LINDEN",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07036-4168",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "908-290-0775",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "423 N WOOD AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LINDEN",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07036-4168",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "908-290-0775",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/27/2025",
    "LastUpdateDate": "10/30/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RODRIGUEZ",
    "AuthorizedOfficialFirstName": "KATHERIN",
    "AuthorizedOfficialMiddleName": "JULIANA",
    "AuthorizedOfficialTitle": "OWNER / MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "732-781-6410",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QH0100X",
        "TaxonomyName": "Health Service Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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