Provider Demographics
NPI:1255873642
Name:PURE ENTERPRISES, LLC
Entity type:Organization
Organization Name:PURE ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDUZ
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:305-297-8583
Mailing Address - Street 1:633 NE 167TH ST
Mailing Address - Street 2:SUITE 1125
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2442
Mailing Address - Country:US
Mailing Address - Phone:305-705-4375
Mailing Address - Fax:
Practice Address - Street 1:633 NE 167TH ST
Practice Address - Street 2:SUITE 1125
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2442
Practice Address - Country:US
Practice Address - Phone:305-705-4375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133840021301261QR0400X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation