Organization
PURE LIFE MEDICAL GROUP , INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS BARBARA GONZALEZ MA (PRESIDENT)
(305) 262-0298
Entity
Organization
Contact information
Practice address
85 GRAND CANAL DR, SUITE 104, MIAMI, FL 33144-2561
(305) 262-0298
(305) 262-1253
Mailing address
85 GRAND CANAL DR, SUITE 104, MIAMI, FL 33144-2561
(305) 262-0298
(305) 262-1253
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
MA67461
FL
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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