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General NPI Number Information
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NPI Number | 1154349371
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1300 W 7TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3505
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Country | US
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Telephone | 310-832-3311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31001-3017
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City | PASADENA
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State | CA
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Zip | 91110-3017
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Country | US
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Telephone | 310-303-7496
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Fax | 310-303-7496
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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