Provider Demographics
NPI:1508172669
Name:RADY CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:RADY CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CHADWICK CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBY
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-966-5803
Mailing Address - Street 1:3665 KEARNY VILLA RD STE 501
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1953
Mailing Address - Country:US
Mailing Address - Phone:406-868-1792
Mailing Address - Fax:
Practice Address - Street 1:3665 KEARNY VILLA RD STE 501
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1953
Practice Address - Country:US
Practice Address - Phone:406-868-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital