Provider Demographics
NPI:1730487349
Name:PARADISE MOBILE IMAGING, LLC
Entity Type:Organization
Organization Name:PARADISE MOBILE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SONOGRAPHER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAVELYNN
Authorized Official - Middle Name:KUULEINANI SATOKO
Authorized Official - Last Name:DEFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RVT, RDMS
Authorized Official - Phone:808-294-8970
Mailing Address - Street 1:98-500 KOAUKA LOOP
Mailing Address - Street 2:7F
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4567
Mailing Address - Country:US
Mailing Address - Phone:808-294-8970
Mailing Address - Fax:888-873-0365
Practice Address - Street 1:98-500 KOAUKA LOOP
Practice Address - Street 2:7F
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4567
Practice Address - Country:US
Practice Address - Phone:808-294-8970
Practice Address - Fax:888-873-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty