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General NPI Number Information
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NPI Number | 1366427734
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Entity Type | Organization
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Legal Business Name | PARADISE FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 655 EUCLID AVE SUITE #207
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2957
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Country | US
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Telephone | 619-475-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 4364 BONITA RD PB #467
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City | BONITA
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State | CA
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Zip | 91902-1421
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Country | US
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Telephone | 619-475-4575
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. BLANCA I FRESNO
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Credential | MD
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Telephone | 619-475-4575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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