1851303994 NPI number — RADY CHILDREN'S HOSPITAL - SAN DIEGO

Table of content: (NPI 1851303994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851303994 NPI number — RADY CHILDREN'S HOSPITAL - SAN DIEGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADY CHILDREN'S HOSPITAL - SAN DIEGO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHILDREN'S HOSPITAL - SAN DIEGO
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851303994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3020 CHILDRENS WAY
Provider Second Line Business Mailing Address:
MAIL CODE 5002
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-4223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-966-4962
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3020 CHILDRENS WAY
Provider Second Line Business Practice Location Address:
MAIL CODE 5002
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-966-4962
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAIN
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. VP/CFO
Authorized Official Telephone Number:
858-966-5824

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  080000028 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 053303 . This is a "BLUE CROSS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 053303 . This is a "GIC INDEMNITY PLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 053303 . This is a "PINNACLE CLAIMS MANAGEMENT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 53125301 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CGP165365 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSC30271F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 053303 . This is a "WESTERN GROWERS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CGP000355 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30271F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40271F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZH3702Z . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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