# PURA VIDA MEDICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922523604
- **Authorized official:** NURY CARBAJAL (OWNER)
- **Authorized official phone:** (305) 874-3909

## Contact information

- **Practice address:** 1738 W 49TH ST STE 7-12, HIALEAH, FL 33012-3456
- **Practice address phone:** (305) 698-8432
- **Practice address fax:** (305) 698-8975
- **Mailing address:** 7925 NW 12TH ST STE 201, DORAL, FL 33126-1821
- **Mailing address phone:** (305) 874-3909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 08/03/2017
- **Last updated:** 06/24/2020