Provider Demographics
NPI:1083999767
Name:RADY CHILREN'S HOSPITAL - SAN DIEGO
Entity Type:Organization
Organization Name:RADY CHILREN'S HOSPITAL - SAN DIEGO
Other - Org Name:RADY CHILDREN'S HOSPITAL - GROSSMONT PEDS SUBACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARETA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
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 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-740-4854
Practice Address - Fax:858-966-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000028282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA053303OtherMEDICARE