Basic Information
| Provider Information | |||||||||
| NPI: | 1992891030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADY CHILDREN'S HOSPITAL & HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3605 VISTA WAY | ||||||||
| Address2: | SUITE 258 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607581480 | ||||||||
| FaxNumber: | 7604359472 | ||||||||
| Practice Location | |||||||||
| Address1: | 3605 VISTA WAY | ||||||||
| Address2: | SUITE 258 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607581480 | ||||||||
| FaxNumber: | 7604359472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | DARLING | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
| AuthorizedOfficialMiddleName: | VIRGINIA | ||||||||
| AuthorizedOfficialTitleorPosition: | SCHOOL PROGRAM COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7607581480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | MFC12569 | CA | N | Hospitals | General Acute Care Hospital | Children | 106H00000X | MFC12569 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.