1457569402 NPI number — RADY CHILDREN'S HOSPITAL SAN DIEGO

Table of content: (NPI 1457569402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457569402 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:
Provider Other Organization Name Type Code:
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:
1457569402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
MC 5010
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:
858-966-5817
Provider Business Mailing Address Fax Number:
858-966-5828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4120 WARING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-758-1620
Provider Business Practice Location Address Fax Number:
858-966-5828
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROUX
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
G
Authorized Official Title or Position:
SR VICE PRESIDENT CFO
Authorized Official Telephone Number:
858-576-1700

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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