Healthcare Provider Details

I. General information

NPI: 1548461619
Provider Name (Legal Business Name): PARADISE ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5921 CLARK RD STE. C
PARADISE CA
95969
US

IV. Provider business mailing address

5921 CLARK RD STE. C
PARADISE CA
95969-4832
US

V. Phone/Fax

Practice location:
  • Phone: 530-876-1407
  • Fax: 530-876-1408
Mailing address:
  • Phone: 530-876-1407
  • Fax: 530-876-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberRDMS 7029
License Number StateNULL

VIII. Authorized Official

Name: SALLY J CASAGRANDE
Title or Position: OWNER
Credential: RDMS
Phone: 530-876-1407