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General NPI Number Information
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NPI Number | 1689875601
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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 | 05/29/2007
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 15031 RINALDI STREET
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City | MISSION HILLS
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State | CA
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Zip | 91345-1207
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Country | US
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Telephone | 818-365-8051
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Fax | 818-898-4569
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Provider Business Mailing Address
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Address Line | 15031 RINALDI STREET
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City | MISSION HILLS
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State | CA
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Zip | 91345-1207
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Country | US
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Telephone | 818-365-8051
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Fax | 818-898-4569
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Authorized Official
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Title or Position | ASSISTANT SECRETARY ENROLLMENTS
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Name | DONALD W 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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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