Healthcare Provider Details

I. General information

NPI: 1457666802
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 H ST SUITE 3010
CHULA VISTA CA
91910-5555
US

IV. Provider business mailing address

3020 CHILDRENS WAY MC 6013
SAN DIEGO CA
92123-4223
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 Number080000028
License Number StateCA

VIII. Authorized Official

Name: VIRGINIA DILLON BIAL
Title or Position: PROGRAM MANAGER
Credential: LCSW
Phone: 858-576-1700