RADY CHILDREN'S HOSPITAL - SAN DIEGO

Provider Demographics

• NPI: 1710065933
• Name: RADY CHILDREN'S HOSPITAL - SAN DIEGO
• Entity Type: Organization
• Organization Name: RADY CHILDREN'S HOSPITAL - SAN DIEGO
• Other - Org Name: CHILDREN'S HOSPITAL - SAN DIEGO
• Other - Org Type: Former Legal Business Name
• Authorized Official - Title/Position: SR. VP/CFO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: JAMES
• Authorized Official - Middle Name: JOSEPH
• Authorized Official - Last Name: ULI
• 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
• Practice Address - Street 1: 3020 CHILDRENS WAY
• Practice Address - Street 2: MAIL CODE 5002
• 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
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-02
• Last Update Date: 2020-07-13

Provider Licenses

State	License ID	Taxonomies
		261Q00000X, 261QD1600X, 261QH0700X, 261QM0855X, 261QP2000X, 261QR0400X, 405300000X
CA	080000028	261QE0700X, 282NC2000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QD1600X	Ambulatory Health Care Facilities	Clinic/Center	Developmental Disabilities
No	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center
No	261QE0700X	Ambulatory Health Care Facilities	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment
No	261QH0700X	Ambulatory Health Care Facilities	Clinic/Center	Hearing and Speech
No	261QM0855X	Ambulatory Health Care Facilities	Clinic/Center	Adolescent and Children Mental Health
No	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy
No	261QR0400X	Ambulatory Health Care Facilities	Clinic/Center	Rehabilitation
No	282NC2000X	Hospitals	General Acute Care Hospital	Children	Group - Multi-Specialty
No	405300000X	Other Service Providers	Prevention Professional		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	053303	Other	WESTERN GROWERS
CA	CGP165365	Medicaid
CA	053303	Other	GIC INDEMNITY PLAN
HI	53125301	Medicaid
CA	CGP000355	Medicaid
CA	ZZZH3702Z	Other	BLUE SHIELD OF CA
CA	HSC30271F	Medicaid
CA	053303	Other	PINNACLE CLAIMS MANAGEMENT
CA	ZZT40271F	Medicaid
CA	053303	Other	BLUE CROSS OF CALIFORNIA
CA	ZZT30271F	Medicaid
HI	53125301	Medicaid
	53303	Medicare Oscar/Certification
	53303	Other	PINNACLE CLAIMS MGMT.
	53303	Other	GIC INDEMNITY PLAN
	53303	Other	UNICARE
CA	ZZT30271F	Medicaid