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NPI Code Detail

MEDICARE: PROVIDENCE SAINT JOHN'S HEALTH CENTER

MEDICARE: PROVIDENCE SAINT JOHN'S HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital930000158CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124026273
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE SAINT JOHN'S HEALTH CENTER
Provider Business Mailing Address
First Line : 1328 22ND ST
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2032
Country : US
Telephone Number : 310-829-5511
Fax Number : 310-315-6135
Provider Business Practice Location Address
First Line : 2121 SANTA MONICA BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2303
Country : US
Telephone Number : 310-829-5511
Fax Number : 310-315-6135
Authorized Official
Title or Position : ASSISTANT SECRETARY ENROLLMENTS
Name : DONALD W ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 07/12/2005
Last Update Date : 05/09/2025

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Directions to “PROVIDENCE SAINT JOHN'S HEALTH CENTER ” Practice Location

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