# PARADISE WEST MEDICAL

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

## Provider details

- **NPI number:** 1912901489
- **Authorized official:** MRS. MARISEL RIVERA (OWNER)
- **Authorized official phone:** (787) 833-1870

## Contact information

- **Practice address:** CALLE TENERIFE, \# 11, MAYAGUEZ, PR 00680-1474
- **Practice address phone:** (787) 833-1870
- **Practice address fax:** (787) 833-1870
- **Mailing address:** PO BOX 582, MAYAGUEZ, PR 00681-0582
- **Mailing address phone:** (787) 833-1870
- **Mailing address fax:** (787) 833-1870

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 5140390001 | PR | Yes |

## Other

- **Enumeration date:** 06/12/2005
- **Last updated:** 08/22/2020