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General NPI Number Information
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NPI Number | 1518349216
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Entity Type | Organization
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Legal Business Name | ST JUDE HOSPITAL YORBA LINDA, INC.
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 3355 MICHELSON DR STE. 490
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City | IRVINE
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State | CA
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Zip | 92612-0684
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Country | US
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Telephone | 949-526-8375
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31001-1920
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City | PASADENA
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State | CA
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Zip | 91110-1920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | TINA MYCROFT
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Credential |
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Telephone | 714-937-7023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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