Provider Demographics
NPI:1104067578
Name:PARAMOUNT PROFESSIONALS INC
Entity type:Organization
Organization Name:PARAMOUNT PROFESSIONALS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:GINALYN
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:TAYAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-509-6059
Mailing Address - Street 1:16484 VICTOR ST.
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3726
Mailing Address - Country:US
Mailing Address - Phone:760-951-6688
Mailing Address - Fax:760-459-2268
Practice Address - Street 1:16484 VICTOR ST.
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3726
Practice Address - Country:US
Practice Address - Phone:760-951-6688
Practice Address - Fax:760-459-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11132008Medicaid
CA059033Medicare Oscar/Certification
CA11132008Medicare PIN