Provider Demographics
NPI:1942954722
Name:PURE CUT ESSENTIALS LLC
Entity Type:Organization
Organization Name:PURE CUT ESSENTIALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-629-1014
Mailing Address - Street 1:5441 NW 179TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5441 NW 179TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3137
Practice Address - Country:US
Practice Address - Phone:954-629-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No291U00000XLaboratoriesClinical Medical Laboratory