Provider Demographics
NPI:1831230648
Name:RADY CHILDRENS HOSPITAL SAN DIEGO
Entity type:Organization
Organization Name:RADY CHILDRENS HOSPITAL SAN DIEGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ULI
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 1:3020 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:858-576-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000028282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30271FMedicaid
CA53303OtherBLUE CROSS OF CALIFORNIA
CACGP165365Medicaid
ZZZH3702ZOtherBLUE SHIELD
53303OtherPINNACLE CLAIMS MGMT.
CAZZT30271FMedicaid
CHHSOtherUNIVERSAL (INACTIVE)
53303OtherUNICARE
53303OtherGIC INDEMNITY PLAN
CACGP000355Medicaid
HI53125301Medicaid
53303OtherWESTERN GROWERS
CAZZT40271FMedicaid
CAZZT40271FMedicaid
53303Medicare Oscar/Certification
CACGP000355Medicaid