Healthcare Provider Details

I. General information

NPI: 1740673193
Provider Name (Legal Business Name): MARK A PARAISO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19005 FALCONS PL
TAMPA FL
33647-2494
US

IV. Provider business mailing address

19005 FALCONS PL
TAMPA FL
33647-2494
US

V. Phone/Fax

Practice location:
  • Phone: 813-399-1433
  • Fax:
Mailing address:
  • Phone: 813-399-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: