Provider Demographics
NPI:1508320862
Name:PURE LIFE ORTHOPEDIC LLC
Entity Type:Organization
Organization Name:PURE LIFE ORTHOPEDIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-238-5266
Mailing Address - Street 1:HC 5 BOX 25902
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9486
Mailing Address - Country:US
Mailing Address - Phone:787-238-5266
Mailing Address - Fax:
Practice Address - Street 1:BO ABRA HONDA
Practice Address - Street 2:CARR 119 R488 KM 0.2
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-685-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier