MEDICARE: RADY CHILDREN'S HOSPITAL SAN DIEGO

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	313M00000X	Nursing Facility/Intermediate Care Facility	090000644	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780756411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADY CHILDREN'S HOSPITAL SAN DIEGO

Provider Business Mailing Address
First Line	:	8022 BIRMINGHAM DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2707
Country	:	US
Telephone Number	:	858-966-5833
Fax Number	:	858-966-8558

Provider Business Practice Location Address
First Line	:	3453 AVELEY PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-4727
Country	:	US
Telephone Number	:	858-541-2646
Fax Number	:	858-966-8558

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JAMES ULI
Credential	:
Telephone Number	:	858-576-1700

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	01/22/2025

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