Healthcare Provider Details

I. General information

NPI: 1881458743
Provider Name (Legal Business Name): SUNSHINE PEDIATRIC DAY CENTER, SAN ANTONIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 MEDINA BASE ROAD
SAN ANTONIO TX
78242
US

IV. Provider business mailing address

13455 NOEL RD # 1250
DALLAS TX
75240-6620
US

V. Phone/Fax

Practice location:
  • Phone: 972-453-1710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: DAVID MAYMON
Title or Position: CEO
Credential:
Phone: 954-881-8230