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General NPI Number Information
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NPI Number | 1801254594
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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 | 02/09/2016
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 925 CORPORATE CNTR PKWY SUITE A
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City | SANTA ROSA
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State | CA
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Zip | 95407-5451
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Country | US
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Telephone | 707-543-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W CENTER STREET PROMENADE STE 400
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City | ANAHEIM
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State | CA
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Zip | 92805-3960
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Country | US
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Telephone | 714-449-4800
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | CA
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