MEDICARE: RADY CHILDREN'S HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	275N00000X	Medicare Defined Swing Bed Hospital Unit

General Provider Information

NPI Number	:	1366658239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADY CHILDREN'S HOSPITAL

Provider Business Mailing Address
First Line	:	4690 COCONINO WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4690 COCONINO WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2612
Country	:	US
Telephone Number	:	619-420-5611
Fax Number	:

Authorized Official
Title or Position	:	CHILD & FAMILY SPECIALIST
Name	:	MRS. ELSA RODRIGUEZ
Credential	:
Telephone Number	:	619-420-5611

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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