Healthcare Provider Details

I. General information

NPI: 1457683237
Provider Name (Legal Business Name): THE PARADISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 S SATE COLLEGE BLVD. STE. 51
FULLERTON CA
92831
US

IV. Provider business mailing address

569 S SATE COLLEGE BLVD. STE. 51
FULLERTON CA
92831
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-1956
  • Fax:
Mailing address:
  • Phone: 714-879-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number101327406
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number101327406
License Number StateCA

VIII. Authorized Official

Name: MS. KARINA HARO
Title or Position: PARTNER
Credential: B.A
Phone: 714-293-8818