Provider Demographics
NPI:1477019776
Name:PARADISE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:PARADISE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:E
Authorized Official - Last Name:CABALO TUDELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-984-5189
Mailing Address - Street 1:4720 SE 15TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9600
Mailing Address - Country:US
Mailing Address - Phone:239-984-2860
Mailing Address - Fax:239-984-5189
Practice Address - Street 1:4720 SE 15TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9600
Practice Address - Country:US
Practice Address - Phone:239-984-2860
Practice Address - Fax:239-984-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies