Provider Demographics
NPI:1477299295
Name:PURA VIDA GROUP L.L.C.
Entity Type:Organization
Organization Name:PURA VIDA GROUP L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHRIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THAYRIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEREZ MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-458-0583
Mailing Address - Street 1:URB VICTOR ROJAS 2
Mailing Address - Street 2:14 CALLE 15
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-458-0583
Mailing Address - Fax:
Practice Address - Street 1:CARR 129 KM 15.1 BO BAYANEY
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-544-3045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty