Healthcare Provider Details

I. General information

NPI: 1033313259
Provider Name (Legal Business Name): ST JUDE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 E IMPERIAL HWY SECOND FLOOR
BREA CA
92821-6713
US

IV. Provider business mailing address

101 E VALENCIA MESA DR
FULLERTON CA
92835-3809
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-3510
  • Fax: 714-870-3525
Mailing address:
  • Phone: 714-992-3000
  • Fax: 714-870-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060000173
License Number StateCA

VIII. Authorized Official

Name: MS. MARGARET ILAGAN
Title or Position: MANAGER, PATIENT FINANCIAL SERVICE
Credential:
Phone: 714-870-3510