Pura Vida Medical Center, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

PURA VIDA MEDICAL CENTER, LLC

Practice address

15529 Bull Run Rd
Miami Lakes, FL 33014-7004

Phone

(305) 328-8922

Fax

(786) 224-6489

NPI assigned

Jul 9, 2020

Organization subpart

Yes

Parent organization

PURA VIDA MEDICAL CENTER, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Nury Carbajal

Title

Ceo

Phone

(305) 874-3909

Specialties & licenses 1

Addresses

Other names 1

• Pura Vida Medical Center Former legal business name

Tax ID family

Pura Vida Medical Center LLC2 organizations share this tax ID, including this one

Part of

Pura Vida Medical Center LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pura Vida Medical Center, LLC

  • General Practice Physician
  • Hialeah, FL
  • NPI 1861040552
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1124646898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7925 NW 12TH ST STE 201",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331261821",
            "telephone_number": "305-874-3909",
            "fax_number": "305-874-3916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15529 BULL RUN RD",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330147004",
            "telephone_number": "305-328-8922",
            "fax_number": "786-224-6489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURA VIDA MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PURA VIDA MEDICAL CENTER, LLC",
        "enumeration_date": "2020-07-09",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "CARBAJAL",
        "authorized_official_first_name": "NURY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-874-3909",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pura Vida Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• General Practice Physician in Miami Lakes, FL
• Providers in Miami Lakes, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.