Organization
PURE LIFE RENAL OF WEST PALM BEACH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF FERNANDEZ (CHIEF FINANCIAL OFFICER)
(954) 962-5733
Entity
Organization
Contact information
Practice address
1522 N DIXIE HWY, WEST PALM BEACH, FL 33401-2720
(954) 962-5733
Mailing address
4000 HOLLYWOOD BLVD STE 300N, HOLLYWOOD, FL 33021-1242
(954) 962-5733
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
10/04/2018
Last updated
12/30/2020
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