Provider Demographics
NPI:1508261736
Name:RADY CHILDRENS HOSPITAL-SAN DIEGO
Entity Type:Organization
Organization Name:RADY CHILDRENS HOSPITAL-SAN DIEGO
Other - Org Name:RADY CHILDRENS HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP/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:858-966-5824
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MAIL CODE 5002
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-1700
Mailing Address - Fax:
Practice Address - Street 1:3665 KEARNY VILLA RD STE 440
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:858-966-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies