Healthcare Provider Details

I. General information

NPI: 1679958037
Provider Name (Legal Business Name): PROVIDENCE ST JOHNS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8317
  • Fax:
Mailing address:
  • Phone: 310-829-8317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberA53519
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN O'DAY
Title or Position: MEDICAL ONCOLOGIST
Credential: MD
Phone: 310-829-8317