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General NPI Number Information
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NPI Number | 1639254188
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Entity Type | Organization
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Legal Business Name | PARADISE MEDICAL CENTER
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1890 NORTH TAMIAMI TRAIL #D2
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903
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Country | US
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Telephone | 239-656-0455
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Fax | 239-656-3010
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Provider Business Mailing Address
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Address Line | 1890 NORTH TAMIAMI TRAIL #D2
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903
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Country | US
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Telephone | 239-656-0455
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Fax | 239-656-3010
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Authorized Official
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Title or Position | PRESIDENT
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Name | EPHRHIM GUTIERREZ AGUILAR
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Credential | MD
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Telephone | 239-656-0455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME16708
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License Number State | FL
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