Healthcare Provider Details

I. General information

NPI: 1306042726
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 01/29/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

7325 VASSAR AVE
LA MESA CA
91941-4721
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-1700
  • Fax:
Mailing address:
  • Phone: 619-461-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number276741
License Number StateCA

VIII. Authorized Official

Name: MS. KERI LEBLANC
Title or Position: DIRECTOR OF NURSE PRACTITIONERS
Credential: NNP
Phone: 858-576-1700