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General NPI Number Information
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NPI Number | 1689950388
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Entity Type | Organization
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Legal Business Name | HEALING PARADISE
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 8040 NW 95TH ST SUITE 220
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2362
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Country | US
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Telephone | 305-820-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 8040 NW 95TH ST SUITE 220
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2362
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Country | US
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Telephone | 305-820-0440
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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. ILEN GONZALEZ
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Credential |
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Telephone | 305-820-0440
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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 | LC9852
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License Number State | FL
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