Provider Demographics
NPI:1740673193
Name:PARAISO, MARK A
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:PARAISO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19005 FALCONS PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2494
Mailing Address - Country:US
Mailing Address - Phone:813-399-1433
Mailing Address - Fax:
Practice Address - Street 1:19005 FALCONS PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2494
Practice Address - Country:US
Practice Address - Phone:813-399-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other