Provider Demographics
NPI:1699853713
Name:RADY CHILDREN'S HEALTH SERVICES-SAN DIEGO
Entity type:Organization
Organization Name:RADY CHILDREN'S HEALTH SERVICES-SAN DIEGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAIN CARRITHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-576-1700
Mailing Address - Street 1:8291 AERO PL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2040
Mailing Address - Country:US
Mailing Address - Phone:858-966-4941
Mailing Address - Fax:858-966-8996
Practice Address - Street 1:8291 AERO PL
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2040
Practice Address - Country:US
Practice Address - Phone:858-966-4941
Practice Address - Fax:858-966-8996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADY CHILDREN'S HOSPITAL - SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA450610Medicaid
CAZZZ00279ZOtherBLUE SHIELD HIP DME
CAZZZ43632ZOtherBLUE SHIELD HIP
CAPHA450610Medicaid