Organization
PARADISE COAST MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON RICHICHI (EXECUTIVE DIRECTOR)
(843) 749-2220
Entity
Organization
Contact information
Practice address
10979 LOST LAKE DR APT 221, NAPLES, FL 34105-3169
(561) 662-4050
Mailing address
10979 LOST LAKE DR APT 221, NAPLES, FL 34105-3169
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
07/14/2023
Last updated
07/14/2023
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