Provider Demographics
NPI:1265732804
Name:PARADISE RADIOLOGY LLC
Entity type:Organization
Organization Name:PARADISE RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSROUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-570-5799
Mailing Address - Street 1:PO BOX 5212
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-5212
Mailing Address - Country:US
Mailing Address - Phone:602-570-5799
Mailing Address - Fax:
Practice Address - Street 1:13216 N PLAZA DEL RIO BLVD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4907
Practice Address - Country:US
Practice Address - Phone:602-570-5799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ335062085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ142374Medicare PIN