Healthcare Provider Details

I. General information

NPI: 1629114525
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL AND HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

4750 NOYES ST APT 216
SAN DIEGO CA
92109-3651
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-1700
  • Fax:
Mailing address:
  • Phone: 619-723-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number15739
License Number StateCA

VIII. Authorized Official

Name: MISS JACQUELINE ELIZABETH STREBEL
Title or Position: NURSE PRACTITIONER
Credential: CPNP
Phone: 858-966-1700