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General NPI Number Information
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NPI Number | 1124666201
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Entity Type | Organization
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Legal Business Name | PARADISE MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 2120 KAOHU ST
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City | WAILUKU
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State | HI
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Zip | 96793-2205
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Country | US
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Telephone | 808-377-4734
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Fax | 808-377-4734
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Provider Business Mailing Address
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Address Line | 2120 KAOHU ST
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City | WAILUKU
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State | HI
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Zip | 96793-2205
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Country | US
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Telephone | 808-377-4734
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Fax | 808-377-4734
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Authorized Official
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Title or Position | PROVIDER/LLC MEMBER
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Name | MRS. JESSICA S B MENDONSA
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Credential | PA-C
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Telephone | 808-377-4734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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