Provider Demographics
NPI:1285916015
Name:PARADIGM MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:PARADIGM MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:CESAR
Authorized Official - Last Name:REYES-GAVILAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-246-7289
Mailing Address - Street 1:16015 SW 102ND LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6173
Mailing Address - Country:US
Mailing Address - Phone:786-655-0095
Mailing Address - Fax:786-870-5651
Practice Address - Street 1:2240 NW 87TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2414
Practice Address - Country:US
Practice Address - Phone:786-655-0095
Practice Address - Fax:786-870-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121514208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004296400Medicaid