Organization
PURA VIDA HEALTH INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER MULHOLLAND DO (OWNER)
(215) 806-6270
Entity
Organization
Contact information
Practice address
215 SUGARTOWN RD, WAYNE, PA 19087-3137
(215) 806-6270
Mailing address
215 SUGARTOWN RD, WAYNE, PA 19087-3137
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS020055
PENNSYLVANIA DEPARTMENT OF STATE - PROFESSIONAL LICENSING BOARD
PA
Enumeration date
01/18/2022
Last updated
07/08/2022
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