Healthcare Provider Details

I. General information

NPI: 1699080051
Provider Name (Legal Business Name): RADY CHILDREN'S HOSPITAL - SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 KEARNY VILLA RD SUITE 500
SAN DIEGO CA
92123-1953
US

IV. Provider business mailing address

3020 CHILDREN'S WAY MC 5016
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-1700
  • Fax: 858-966-5992
Mailing address:
  • Phone: 858-576-1700
  • Fax: 858-966-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number080000028
License Number StateCA

VIII. Authorized Official

Name: VIRGINIA DILLON BIAL
Title or Position: PROGRAM MANAGER
Credential: LCSW
Phone: 858-576-1700