MEDICARE: CORNERSTONE PEDIATRICS NIGHT CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	L9596	TX

General Provider Information

NPI Number	:	1528409786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE PEDIATRICS NIGHT CLINIC

Provider Business Mailing Address
First Line	:	3660 JOE BATTLE BLVD
Second Line	:	SUITE 8
City	:	EL PASO
State	:	TX
Zip	:	79938-2628
Country	:	US
Telephone Number	:	915-921-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3660 JOE BATTLE BLVD
Second Line	:	SUITE 8
City	:	EL PASO
State	:	TX
Zip	:	79938-2628
Country	:	US
Telephone Number	:	915-921-0500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. AKINTOLUWA ANTHONY AKINJAIYEJU
Credential	:	MD
Telephone Number	:	915-821-5900

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	07/16/2013

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