Healthcare Provider Details

I. General information

NPI: 1801923941
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 CITRACADO PKWY STE 200
ESCONDIDO CA
92029-4159
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5097
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 760-294-9270
  • Fax: 760-294-9268
Mailing address:
  • Phone: 858-576-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: JAMES ULI
Title or Position: SR. VP, CFO
Credential:
Phone: 858-966-5824