Healthcare Provider Details

I. General information

NPI: 1003095589
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 01/30/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W CITRACADO PKWY SUITE 102
ESCONDIDO CA
92025-6428
US

IV. Provider business mailing address

625 W CITRACADO PKWY SUITE 102
ESCONDIDO CA
92025-6428
US

V. Phone/Fax

Practice location:
  • Phone: 760-294-9270
  • Fax: 760-294-9268
Mailing address:
  • Phone: 760-294-9270
  • Fax: 760-294-9268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES J ULI
Title or Position: SR. VICE PRESIDENT, CFO
Credential:
Phone: 858-966-5824