Provider Demographics
NPI:1558372177
Name:NIGHT OWL PEDIATRICS, INC
Entity Type:Organization
Organization Name:NIGHT OWL PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:925-229-4273
Mailing Address - Street 1:425 GREGORY LN
Mailing Address - Street 2:#203
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2880
Mailing Address - Country:US
Mailing Address - Phone:925-288-3600
Mailing Address - Fax:925-288-3606
Practice Address - Street 1:425 GREGORY LN
Practice Address - Street 2:#203
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2880
Practice Address - Country:US
Practice Address - Phone:925-288-3600
Practice Address - Fax:925-288-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A58292080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA69461Medicare UPIN