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General NPI Number Information
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NPI Number | 1467551408
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Entity Type | Organization
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Legal Business Name | GOOD NIGHT PEDIATRCS
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 19272 STONE OAK PKWY SUITE 107
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3371
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Country | US
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Telephone | 210-545-7581
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Fax | 210-545-7041
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Provider Business Mailing Address
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Address Line | PO BOX 1222
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City | SAN ANTONIO
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State | TX
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Zip | 78294-1222
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Country | US
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Telephone | 210-545-7581
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Fax | 210-545-7041
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. ELLEN SUTHERLAND
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Credential | M.D.
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Telephone | 210-545-7581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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