Healthcare Provider Details

I. General information

NPI: 1609982875
Provider Name (Legal Business Name): ELIZABETH GOEBEL NUTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NIGHT OWL PEDIATRICS 425 GREGORY LANE SUITE 203
PLEASANT HILL CA
94523
US

IV. Provider business mailing address

225 DEVONSHIRE CT
PLEASANT HILL CA
94523
US

V. Phone/Fax

Practice location:
  • Phone: 925-288-3600
  • Fax: 925-288-3606
Mailing address:
  • Phone: 925-933-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA068426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: