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General NPI Number Information
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NPI Number | 1720393176
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Entity Type | Organization
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Legal Business Name | RADY CHILDREN'S HOSPITAL - SAN DIEGO
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 2204 EL CAMINO REAL SUITE 102
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City | OCEANSIDE
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State | CA
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Zip | 92054
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Country | US
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Telephone | 760-967-7082
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Fax | 760-967-7082
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Provider Business Mailing Address
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Address Line | 3020 CHILDRENS WAY MC 6001
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City | SAN DIEGO
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State | CA
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Zip | 92123-4223
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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 | PROGRAM MANAGER
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Name | VIRGINIA DILLON BIAL
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Credential | LCSW
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Telephone | 858-576-1700
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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 | 080000028
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License Number State | CA
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