Provider Demographics
NPI:1952131260
Name:PUR AESTHETICS
Entity type:Organization
Organization Name:PUR AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IVES
Authorized Official - Middle Name:
Authorized Official - Last Name:JODESTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-559-4818
Mailing Address - Street 1:331 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1975
Mailing Address - Country:US
Mailing Address - Phone:954-688-7255
Mailing Address - Fax:
Practice Address - Street 1:331 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1975
Practice Address - Country:US
Practice Address - Phone:954-688-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207N00000XAllopathic & Osteopathic PhysiciansDermatology