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General NPI Number Information
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NPI Number | 1306384185
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Entity Type | Organization
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Legal Business Name | ST. JUDE HOSPITAL YORBA LINDA
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 4 PARK PLZ SUITE 150
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City | IRVINE
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State | CA
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Zip | 92614-8560
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Country | US
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Telephone | 949-430-3963
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Fax | 949-430-3964
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Provider Business Mailing Address
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Address Line | 4 PARK PLZ SUITE 150
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City | IRVINE
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State | CA
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Zip | 92614-8560
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Country | US
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Telephone | 949-430-3963
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Fax | 949-430-3964
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Authorized Official
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Title or Position | CHIEF ADMINISTRATION OFFICER
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Name | JOHN BENNETT
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Credential |
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Telephone | 714-449-4942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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