Provider Demographics
NPI:1780756411
Name:RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity type:Organization
Organization Name:RADY CHILDREN'S HOSPITAL SAN DIEGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ULI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-576-1700
Mailing Address - Street 1:8022 BIRMINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2707
Mailing Address - Country:US
Mailing Address - Phone:858-966-5833
Mailing Address - Fax:858-966-8558
Practice Address - Street 1:3453 AVELEY PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4727
Practice Address - Country:US
Practice Address - Phone:858-541-2646
Practice Address - Fax:858-966-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000644313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80295FMedicaid
CA053303Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER