Provider Demographics
NPI:1699080051
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 CHILDREN'S WAY
Mailing Address - Street 2:MC 5016
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-576-1700
Mailing Address - Fax:858-966-5992
Practice Address - Street 1:3665 KEARNY VILLA RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1953
Practice Address - Country:US
Practice Address - Phone:858-966-1700
Practice Address - Fax:858-966-5992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADY CHILDREN'S HOSPITAL - SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-10
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000028282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren