Healthcare Provider Details

I. General information

NPI: 1083999767
Provider Name (Legal Business Name): RADY CHILREN'S HOSPITAL SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 01/30/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

8022 BIRMINGHAM DR
SAN DIEGO CA
92123-2707
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-4854
  • Fax: 858-966-8558
Mailing address:
  • Phone: 858-966-5833
  • Fax: 858-966-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number080000028
License Number StateCA

VIII. Authorized Official

Name: JAMES ULI
Title or Position: SR. V.P./CFO
Credential:
Phone: 858-576-1700