Provider Demographics
NPI:1154613818
Name:RADY CHILDREN'S HOSPITAL SAN DIEGO
Entity type:Organization
Organization Name:RADY CHILDREN'S HOSPITAL SAN DIEGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:DILLON
Authorized Official - Last Name:BIAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-576-1700
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC 5023
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-5990
Mailing Address - Fax:858-966-7803
Practice Address - Street 1:3601 VISTA WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4559
Practice Address - Country:US
Practice Address - Phone:858-966-1700
Practice Address - Fax:858-966-7803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADY CHILDREN'S HOSPITAL SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-12
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X, 282N00000X
CA080000028282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty