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General NPI Number Information
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NPI Number | 1336161785
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Entity Type | Organization
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Legal Business Name | PARADISE MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 809 MOLUCAS STREET COUNTRY CLUB
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City | SAN JUAN
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State | PR
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Zip | 00924-1701
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Country | US
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Telephone | 787-633-7423
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Fax |
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Provider Business Mailing Address
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Address Line | 352 SAN CLAUDIO ST. , PMB 274 URB. SAGRADO CORAZON
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City | SAN JUAN
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State | PR
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Zip | 00926-4143
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Country | US
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Telephone | 787-633-7423
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MYRNA RIVERA
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Credential |
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Telephone | 787-633-7423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 4308950001
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License Number State | PR
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