Healthcare Provider Details

I. General information

NPI: 1972914075
Provider Name (Legal Business Name): PARADISE HEARING AND BALANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 N 108TH AVE SUITE 120
PHOENIX AZ
85037-5773
US

IV. Provider business mailing address

4120 N 108TH AVE SUITE 120
PHOENIX AZ
85037-5773
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-8750
  • Fax: 623-218-1544
Mailing address:
  • Phone: 623-877-8750
  • Fax: 623-218-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHAD 1603
License Number StateAZ

VIII. Authorized Official

Name: ZACHARY KENNETH MILLS
Title or Position: PRESIDENT
Credential:
Phone: 623-877-8750