Provider Demographics
NPI:1902019300
Name:GOOD NIGHT PEDIATRICS
Entity Type:Organization
Organization Name:GOOD NIGHT PEDIATRICS
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICS
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:EL-GASIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD FAAP
Authorized Official - Phone:602-476-0000
Mailing Address - Street 1:750 E NORTHERN AVE UNIT 1070
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4174
Mailing Address - Country:US
Mailing Address - Phone:202-207-5608
Mailing Address - Fax:
Practice Address - Street 1:1440 E MISSOURI AVE # C200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2458
Practice Address - Country:US
Practice Address - Phone:602-476-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36344146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty