Provider Demographics
NPI:1770607830
Name:SOUTHWEST PEDIATRIC NIGHT CLINIC OF EL PASO, P.A.
Entity type:Organization
Organization Name:SOUTHWEST PEDIATRIC NIGHT CLINIC OF EL PASO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-590-5600
Mailing Address - Street 1:10460 VISTA DEL SOL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7939
Mailing Address - Country:US
Mailing Address - Phone:915-633-9276
Mailing Address - Fax:915-633-9276
Practice Address - Street 1:10460 VISTA DEL SOL DR STE 303
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7939
Practice Address - Country:US
Practice Address - Phone:915-633-9276
Practice Address - Fax:915-633-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149955001Medicaid
TX149955001Medicaid
TX149955001Medicaid