Provider Demographics
NPI:1578094025
Name:RADY CHILDREN'S HOSPITAL-SAN DIEGO
Entity Type:Organization
Organization Name:RADY CHILDREN'S HOSPITAL-SAN DIEGO
Other - Org Name:RADY C.E.S. - SATELLITE 1
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-966-5824
Mailing Address - Street 1:3020 CHILDREN'S WAY - MC 5018
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-966-8459
Mailing Address - Fax:858-966-8470
Practice Address - Street 1:4305 UNIVERSITY AVENUE, SUITE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:858-966-5484
Practice Address - Fax:858-966-5482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADY CHILDREN'S HOSPITAL-SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit