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General NPI Number Information
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NPI Number | 1245765924
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Entity Type | Organization
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Legal Business Name | PARADISE SURGERY CENTER
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 6283 CLARK RD SUITE 11
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City | PARADISE
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State | CA
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Zip | 95969-4100
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Country | US
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Telephone | 530-514-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 6283 CLARK RD SUITE 11
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City | PARADISE
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State | CA
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Zip | 95969-4100
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Country | US
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Telephone | 530-514-8282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEROME NISWONGER
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Credential | M.D.
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Telephone | 530-514-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 05C001855
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License Number State | CA
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