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General NPI Number Information
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NPI Number | 1235849779
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Entity Type | Organization
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Legal Business Name | PARADISE LIFESTYLE LLC
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 810 S ALMA SCHOOL RD STE 4
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City | MESA
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State | AZ
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Zip | 85210-1091
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Country | US
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Telephone | 480-699-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 810 S ALMA SCHOOL RD STE 4
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City | MESA
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State | AZ
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Zip | 85210-1091
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Country | US
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Telephone | 480-699-9299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANNA NGUYEN
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Credential |
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Telephone | 480-699-9299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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