Provider Demographics
NPI:1326215674
Name:PARADISE VALLEY HOSPITAL
Entity type:Organization
Organization Name:PARADISE VALLEY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:619-470-4110
Mailing Address - Street 1:280 TROUSDALE DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-1079
Mailing Address - Country:US
Mailing Address - Phone:619-426-4662
Mailing Address - Fax:619-426-4362
Practice Address - Street 1:280 TROUSDALE DR STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1079
Practice Address - Country:US
Practice Address - Phone:619-426-4662
Practice Address - Fax:619-426-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1048440001Medicare NSC