Organization Name: | ST. JUDE HOSPITAL, INC. |
NPI Number: | 1063534501 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BARRY ROSS (VICE PRESIDENT, HEALTHY COMMUNITIES) |
Mailing Address: | 7758 Knott Ave Buena Park |
State: | CA US |
Postal Code: | 906202420 |
Phone Number: | 7145228723 |
Fax Number: | |
NPI Enumeration Date: | 04/04/2007 |
NPI Last Update Date: | 11/28/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |