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General NPI Number Information
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NPI Number | 1942247291
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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 | 06/02/2006
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 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 | 310-303-7496
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Fax | 310-303-7575
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Provider Business Mailing Address
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Address Line | PO BOX 2335
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City | SPOKANE
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State | WA
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Zip | 99210-2335
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Country | US
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Telephone | 310-303-7496
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Fax | 310-303-7575
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | CA
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