Healthcare Provider Details

I. General information

NPI: 1356475313
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL, CHADWICK CENTER FOR CHILDREN AND FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 3RD AVE SUITE D
CHULA VISTA CA
91911-3262
US

IV. Provider business mailing address

1261 3RD AVE SUITE D
CHULA VISTA CA
91911-3262
US

V. Phone/Fax

Practice location:
  • Phone: 619-420-5611
  • Fax: 619-420-5531
Mailing address:
  • Phone: 619-420-5611
  • Fax: 619-420-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberLCS16941
License Number StateCA

VIII. Authorized Official

Name: MS. HEIDI LYNN STERN-ELLIS
Title or Position: CLINICAL SUPERVISOR
Credential: LCSW
Phone: 619-420-5611