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General NPI Number Information
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NPI Number | 1558695239
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Entity Type | Organization
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Legal Business Name | 1 PARADISE MEDICAL INC
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 13155 SW 134TH ST STE 221
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City | MIAMI
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State | FL
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Zip | 33186-4486
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Country | US
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Telephone | 786-333-3369
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Fax | 305-677-9048
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Provider Business Mailing Address
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Address Line | 13155 SW 134TH ST STE 221
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City | MIAMI
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State | FL
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Zip | 33186-4486
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Country | US
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Telephone | 786-333-3369
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Fax | 305-677-9048
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIRENIA BUSTILLO
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Credential |
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Telephone | 786-333-3369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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