Provider Demographics
NPI:1558695239
Name:1 PARADISE MEDICAL INC
Entity Type:Organization
Organization Name:1 PARADISE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-333-3369
Mailing Address - Street 1:13155 SW 134TH ST
Mailing Address - Street 2:STE 221
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4486
Mailing Address - Country:US
Mailing Address - Phone:786-333-3369
Mailing Address - Fax:305-677-9048
Practice Address - Street 1:13155 SW 134TH ST
Practice Address - Street 2:STE 221
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4486
Practice Address - Country:US
Practice Address - Phone:786-333-3369
Practice Address - Fax:305-677-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation