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General NPI Number Information
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NPI Number | 1235111006
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Entity Type | Organization
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Legal Business Name | PARADISE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 6470 PENTZ RD SUITE A
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City | PARADISE
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State | CA
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Zip | 95969-3674
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Country | US
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Telephone | 530-872-6650
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Fax | 530-872-6653
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Provider Business Mailing Address
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Address Line | 6470 PENTZ RD SUITE A
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City | PARADISE
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State | CA
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Zip | 95969-3674
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Country | US
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Telephone | 530-872-6650
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Fax | 530-872-6653
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RICHARD E. THORP
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Credential | M.D.
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Telephone | 530-872-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 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 #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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