Basic Information
| Provider Information | |||||||||
| NPI: | 1457587677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADY CHILDREN HOSPITAL AND HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1261 3RD AVE | ||||||||
| Address2: | D | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919113262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194205611 | ||||||||
| FaxNumber: | 6194205531 | ||||||||
| Practice Location | |||||||||
| Address1: | 1261 3RD AVE | ||||||||
| Address2: | D | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919113262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194205611 | ||||||||
| FaxNumber: | 6194205531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2009 | ||||||||
| LastUpdateDate: | 06/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | SOCIAL WORKER 1 | ||||||||
| AuthorizedOfficialTelephone: | 6194205611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | ASW16491 | CA | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.