Healthcare Provider Details

I. General information

NPI: 1992891030
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL & HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 VISTA WAY SUITE 258
OCEANSIDE CA
92056-3619
US

IV. Provider business mailing address

3605 VISTA WAY SUITE 258
OCEANSIDE CA
92056-3619
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberMFC12569
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC12569
License Number StateCA

VIII. Authorized Official

Name: MS. JULIA VIRGINIA DARLING
Title or Position: SCHOOL PROGRAM COORDINATOR
Credential: MFT
Phone: 760-758-1480