Healthcare Provider Details

I. General information

NPI: 1114054202
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

3605 VISTA WAY SUITE 258
OCEANSIDE CA
92056-4565
US

IV. Provider business mailing address

3020 CHILDRENS WAY MC 5018
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1480
  • Fax: 760-435-9472
Mailing address:
  • Phone: 858-576-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES ULI
Title or Position: SR VICE PRESIDENT CFO
Credential:
Phone: 858-576-1700