Provider Demographics
NPI:1104205335
Name:RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity Type:Organization
Organization Name:RADY CHILDREN'S HOSPITAL SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN
Authorized Official - Prefix:MS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-443-1416
Mailing Address - Street 1:625 CITRACADO PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6428
Mailing Address - Country:US
Mailing Address - Phone:760-294-9270
Mailing Address - Fax:
Practice Address - Street 1:625 CITRACADO PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-294-9270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren