Healthcare Provider Details

I. General information

NPI: 1376618553
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL - SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY # MC5019
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5019
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-5833
  • Fax: 858-576-8558
Mailing address:
  • Phone: 858-576-5833
  • Fax: 858-576-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number080000028
License Number StateCA

VIII. Authorized Official

Name: KATHY MARIE CAIN CARRITHERS
Title or Position: SR. VP & CHIEF FINANCIAL OFFICER
Credential:
Phone: 858-576-1700