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General NPI Number Information
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NPI Number | 1922651561
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Entity Type | Organization
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Legal Business Name | PROVIDENCE FACEY MEDICAL FOUNDATION
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 14550 SOLEDAD CANYON RD
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City | SANTA CLARITA
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State | CA
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Zip | 91387-2200
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Country | US
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Telephone | 818-837-5559
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Fax |
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Provider Business Mailing Address
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Address Line | FILE 50670
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City | LOS ANGELES
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State | CA
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Zip | 90074-0670
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Country | US
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Telephone | 818-837-5559
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Fax |
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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