Provider Demographics
NPI:1295537819
Name:CHILDS, RANDI-LERAY JUNE (CSFA)
Entity type:Individual
Prefix:
First Name:RANDI-LERAY
Middle Name:JUNE
Last Name:CHILDS
Suffix:
Gender:
Credentials:CSFA
Other - Prefix:
Other - First Name:RANDI-LERAY
Other - Middle Name:JUNE
Other - Last Name:SOWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4322 HOLLOW HILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1718
Mailing Address - Country:US
Mailing Address - Phone:859-307-0057
Mailing Address - Fax:
Practice Address - Street 1:3619 PAESANOS PKWY STE 302
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1259
Practice Address - Country:US
Practice Address - Phone:210-496-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206701246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant