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General NPI Number Information
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NPI Number | 1336438902
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Entity Type | Organization
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Legal Business Name | SAINT JOHN'S HEALTH CLINIC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 2121 SANTA MONICA BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90404-2303
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Country | US
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Telephone | 310-829-8754
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Fax | 310-829-8062
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Provider Business Mailing Address
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Address Line | PO BOX 31001-3029
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City | PASADENA
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State | CA
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Zip | 91110-3029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY FOR ENROLLMENT
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Name | DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-525-5392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A74690
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G34311
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A102707
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G27424
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A76881
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A108734
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A81646
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G70184
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License Number State | CA
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Taxonomy #9
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A76707
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License Number State | CA
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Taxonomy #10
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G31595
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License Number State | CA
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