=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457666802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADY CHILDREN'S HOSPITAL SAN DIEGO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2010
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 H ST SUITE 3010
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91910-5555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-420-5611
-----------------------------------------------------
Fax | 619-420-5531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3020 CHILDRENS WAY MC 6013
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-4223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-420-5611
-----------------------------------------------------
Fax | 619-420-5531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | VIRGINIA DILLON BIAL
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 858-576-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC2000X
-----------------------------------------------------
Taxonomy Name | Children's Hospital
-----------------------------------------------------
License Number | 080000028
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------