=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548818891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADIGM STAFFING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2019
-----------------------------------------------------
Last Update Date | 08/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8118 GOOD LUCK RD
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-3574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-230-3933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 DOUGLAS DR
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-7183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-230-3933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. JOSEPH CHRISTOPHER LUNA
-----------------------------------------------------
Credential | CSFA
-----------------------------------------------------
Telephone | 808-230-3933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------