MEDICARE: PROVIDENCE FACEY MEDICAL FOUNDATION

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
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1922651561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE FACEY MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	FILE 50670
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-0670
Country	:	US
Telephone Number	:	818-837-5559
Fax Number	:

Provider Business Practice Location Address
First Line	:	14550 SOLEDAD CANYON RD
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91387-2200
Country	:	US
Telephone Number	:	818-837-5559
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY OF ENROLLMENTS
Name	:	DONALD WAYNE ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	05/13/2025

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