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General NPI Number Information
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NPI Number | 1063236461
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Entity Type | Organization
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Legal Business Name | PARAGON MEDICAL ALLIANCE LLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 3690 GRANT DR UNIT L2
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City | RENO
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State | NV
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Zip | 89509-5476
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Country | US
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Telephone | 775-527-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 3690 GRANT DR UNIT L2
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City | RENO
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State | NV
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Zip | 89509-5476
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Country | US
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Telephone | 775-527-3621
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Fax |
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Authorized Official
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Title or Position | OWNER/EXECUTIVE OFFICER
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Name | MINMIN SONG
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Credential |
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Telephone | 775-527-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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