Healthcare Provider Details

I. General information

NPI: 1679103873
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL RESEARCH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 240
SAN DIEGO CA
92123-2781
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5129
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-8127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateNULL

VIII. Authorized Official

Name: LYNN PEREZ
Title or Position: SVP, EXECUTIVE DIRECTOR
Credential:
Phone: 858-576-1700