Organization
RADY CHILDREN'S HEALTH SERVICES-SAN DIEGO
Active
Other names
San Diego Children's Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TIFFANY LYNN KAVANAUGH (OFFICE MANAGER)
(858) 966-5802
Entity
Organization
Contact information
Practice address
3020 CHILDRENS WAY, MAILCODE 5127, SAN DIEGO, CA 92123-4223
(858) 576-1700
(858) 966-8097
Mailing address
3020 CHILDRENS WAY, MAILCODE 5127, SAN DIEGO, CA 92123-4223
(858) 576-1700
(858) 966-8097
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G93636-01
—
CA
01
—
G98449-01
HEALTHY FAMILY STATE PROG
CA
Enumeration date
10/11/2006
Last updated
08/22/2020
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