Healthcare Provider Details

I. General information

NPI: 1104205335
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CITRACADO PKWY SUITE 102
ESCONDIDO CA
92025-6428
US

IV. Provider business mailing address

625 CITRACADO PKWY SUITE 102
ESCONDIDO CA
92025-6428
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MONA ELAINE HOGAN
Title or Position: INTERN
Credential:
Phone: 760-443-1416