# PARADISE COAST MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033898309
- **Authorized official:** JASON RICHICHI (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (843) 749-2220

## Contact information

- **Practice address:** 10979 LOST LAKE DR APT 221, NAPLES, FL 34105-3169
- **Practice address phone:** (561) 662-4050
- **Mailing address:** 10979 LOST LAKE DR APT 221, NAPLES, FL 34105-3169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/14/2023
- **Last updated:** 07/14/2023