12D2217372 CLIA NUMBER - PARADISE MEDICAL SERVICES LLC

Laboratory Demographics

CLIA Number: 12D2217372

Facility Name: PARADISE MEDICAL SERVICES LLC

Facility Address:
2120 KAOHU STREET
WAILUKU, HI
ZIP 96793
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Facility Phone Number: 808 377-4734

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1124666201

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	12D2217372
LAB Type	Mobile Laboratory
Facility Name	PARADISE MEDICAL SERVICES LLC
Street	2120 KAOHU STREET
City	WAILUKU
State	HI
ZIP	96793
Phone	808 377-4734
CertificateType	4
CertificateEffectiveDate	3/19/2023
CertificateExpirationDate	3/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024