=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831230648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADY CHILDRENS HOSPITAL SAN DIEGO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3020 CHILDRENS WAY MAIL CODE 5002
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-4223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-576-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3020 CHILDRENS WAY MAIL CODE 5002
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-4223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-966-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VP CFO
-----------------------------------------------------
Name | MR. JAMES J ULI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-966-5824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC2000X
-----------------------------------------------------
Taxonomy Name | Children's Hospital
-----------------------------------------------------
License Number | 080000028
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------