# PROVIDENCE LITTLE CO. OF MARY HOSPITAL IN SAN PEDRO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023761715
- **Authorized official:** ARNULFO TARROBAGO FERNANDEZ JR. RN (PET TEAM)
- **Authorized official phone:** (310) 514-5480

## Contact information

- **Practice address:** 1300 W 7TH ST, SAN PEDRO, CA 90732-3505
- **Practice address phone:** (310) 514-5480
- **Mailing address:** 1018 8TH ST, HERMOSA BEACH, CA 90254-4311
- **Mailing address phone:** (310) 936-6161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WC1500X | Community Health Registered Nurse | — | NULL | Yes |
| 163WC1500X | Community Health Registered Nurse | — | — | Yes |

## Other

- **Enumeration date:** 02/02/2022
- **Last updated:** 02/02/2022