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General NPI Number Information
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NPI Number | 1356475313
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOSPITAL, CHADWICK CENTER FOR CHILDREN AND FAMILIES
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 1261 3RD AVE SUITE D
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City | CHULA VISTA
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State | CA
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Zip | 91911-3262
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Country | US
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Telephone | 619-420-5611
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Fax | 619-420-5531
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Provider Business Mailing Address
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Address Line | 1261 3RD AVE SUITE D
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City | CHULA VISTA
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State | CA
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Zip | 91911-3262
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Country | US
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Telephone | 619-420-5611
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Fax | 619-420-5531
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MS. HEIDI LYNN STERN-ELLIS
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Credential | LCSW
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Telephone | 619-420-5611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | LCS16941
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License Number State | CA
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