Healthcare Provider Details

I. General information

NPI: 1831230648
Provider Name (Legal Business Name): RADY CHILDRENS HOSPITAL SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY MAIL CODE 5002
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3020 CHILDRENS WAY MAIL CODE 5002
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

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

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: MR. JAMES J ULI
Title or Position: SR VP CFO
Credential:
Phone: 858-966-5824