Provider Demographics
NPI:1518235720
Name:RADY CHILDREN HOSPITAL AND HEALTH CENTER
Entity Type:Organization
Organization Name:RADY CHILDREN HOSPITAL AND HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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:8589-661-7005
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:5081
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:858-966-5425
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:5081
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-1700
Practice Address - Fax:858-966-5425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15277282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren