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General NPI Number Information
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NPI Number | 1821010315
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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 | 07/24/2006
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 4101 TORRANCE BLVD
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City | TORRANCE
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State | CA
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Zip | 90503-4607
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Country | US
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Telephone | 310-303-5777
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Fax | 310-303-5778
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Provider Business Mailing Address
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Address Line | 4101 TORRANCE BLVD
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City | TORRANCE
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State | CA
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Zip | 90503-4607
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Country | US
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Telephone | 310-303-5722
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Fax | 310-303-5779
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | HSP47224
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License Number State | CA
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