Healthcare Provider Details

I. General information

NPI: 1699553701
Provider Name (Legal Business Name): PARADISE HEALTHCARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 SW 137TH AVE STE 116A
MIAMI FL
33186-1437
US

IV. Provider business mailing address

9010 SW 137TH AVE STE 116A
MIAMI FL
33186-1437
US

V. Phone/Fax

Practice location:
  • Phone: 786-963-0121
  • Fax: 786-963-0138
Mailing address:
  • Phone: 786-963-0121
  • Fax: 786-963-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAYANIS M REYES RAMIREZ
Title or Position: CEO
Credential:
Phone: 786-765-8910