Provider Demographics
NPI:1770771669
Name:CHILDREN'S NIGHT CLINIC, P.A.
Entity type:Organization
Organization Name:CHILDREN'S NIGHT CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GOMEZ
Authorized Official - Last Name:PENON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-922-4070
Mailing Address - Street 1:PO BOX 241959
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-8959
Mailing Address - Country:US
Mailing Address - Phone:210-922-4070
Mailing Address - Fax:210-922-7818
Practice Address - Street 1:102 PALO ALTO RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3758
Practice Address - Country:US
Practice Address - Phone:210-922-4070
Practice Address - Fax:210-922-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5510261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care