Provider Demographics
NPI:1548461619
Name:PARADISE ULTRASOUND
Entity type:Organization
Organization Name:PARADISE ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASAGRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:530-876-1407
Mailing Address - Street 1:5921 CLARK RD
Mailing Address - Street 2:STE. C
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4832
Mailing Address - Country:US
Mailing Address - Phone:530-876-1407
Mailing Address - Fax:530-876-1408
Practice Address - Street 1:5921 CLARK RD
Practice Address - Street 2:STE. C
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969
Practice Address - Country:US
Practice Address - Phone:530-876-1407
Practice Address - Fax:530-876-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RDMS 70292471S1302X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51231Medicare UPIN
CAE52587Medicare UPIN