Provider Demographics
NPI:1396283453
Name:ST. JUDE HOSPITAL YORBA LINDA
Entity type:Organization
Organization Name:ST. JUDE HOSPITAL YORBA LINDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-449-4942
Mailing Address - Street 1:57 PRISM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3148
Mailing Address - Country:US
Mailing Address - Phone:949-430-3960
Mailing Address - Fax:949-430-3961
Practice Address - Street 1:57 PRISM
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3148
Practice Address - Country:US
Practice Address - Phone:949-430-3960
Practice Address - Fax:949-430-3961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site