MEDICARE: PURE LIFE MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1275250433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE LIFE MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	3637 DEL PRADO BLVD S STE 305
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7199
Country	:	US
Telephone Number	:	239-269-8767
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 DEL PRADO BLVD S STE 305
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7199
Country	:	US
Telephone Number	:	239-269-8767
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YENISLEYDIS PADRON
Credential	:
Telephone Number	:	239-269-8767

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	01/20/2026

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Directions to “PURE LIFE MEDICAL GROUP LLC ” Practice Location

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