Basic Information
| Provider Information | |||||||||
| NPI: | 1083823512 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADY CHILDRENS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1659 COUNTRYSIDE DR | ||||||||
| Address2: | |||||||||
| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920818725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607341629 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3142 VISTA WAY | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609677082 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NEFF | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHILD FAMILY SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7609677082 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.