Provider Demographics
NPI:1871940445
Name:PARADISE MEDICAL CENTER INC
Entity type:Organization
Organization Name:PARADISE MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-536-2558
Mailing Address - Street 1:8380 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4180
Mailing Address - Country:US
Mailing Address - Phone:865-362-5587
Mailing Address - Fax:786-536-2929
Practice Address - Street 1:8380 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:786-536-2558
Practice Address - Fax:786-536-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9360319251E00000X
FLANRP9360319261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251E00000XAgenciesHome Health