Healthcare Provider Details

I. General information

NPI: 1669453932
Provider Name (Legal Business Name): PARADISE VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E 4TH ST
NATIONAL CITY CA
91950-2026
US

IV. Provider business mailing address

2400 E 4TH ST
NATIONAL CITY CA
91950-2026
US

V. Phone/Fax

Practice location:
  • Phone: 619-470-4321
  • Fax:
Mailing address:
  • Phone: 619-470-4321
  • Fax: 619-470-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. GARY R FOLL
Title or Position: CFO
Credential:
Phone: 619-470-4110