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NPI Code Detail

MEDICARE: PARADISE MEDICAL ENTERPRISES

MEDICARE: PARADISE MEDICAL ENTERPRISES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianM07-02190-1-080989NV

General Provider Information

NPI Number : 1790819282
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARADISE MEDICAL ENTERPRISES
Provider Business Mailing Address
First Line : 2881 S VALLEY VW
Second Line : SUITE 15
City : LAS VEGAS
State : NV
Zip : 89102-0100
Country : US
Telephone Number : 702-474-6300
Fax Number : 702-974-0108
Provider Business Practice Location Address
First Line : 2881 S VALLEY VIEW
Second Line : SUITE 15
City : LAS VEGAS
State : NV
Zip : 89102-0100
Country : US
Telephone Number : 702-474-6300
Fax Number : 702-974-0108
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MR. JAMES EGIDIO
Credential :
Telephone Number : 702-474-6300
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/29/2011

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Directions to “PARADISE MEDICAL ENTERPRISES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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