Healthcare Provider Details

I. General information

NPI: 1316183999
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2009
Last Update Date: 01/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # MC8450
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

200 W ARBOR DR # MC8450
SAN DIEGO CA
92103-9001
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-4003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA103185
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberA103185
License Number StateCA

VIII. Authorized Official

Name: DR. MONICA M ZHEREBTSOV
Title or Position: PHYSICIAN
Credential: MD
Phone: 858-966-4003