Provider Demographics
NPI:1356477806
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:SR VICE PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-576-1700
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC 5018
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-576-1700
Mailing Address - Fax:
Practice Address - Street 1:5650 MOUNT ACKERLY DR
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4016
Practice Address - Country:US
Practice Address - Phone:858-496-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit