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Organization
ST. MARY MEDICAL CENTER
Active
Organization
ST. MARY MEDICAL CENTER
Active
Other names
Providence St. Mary Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL CASTILLO (CHIEF EXECUTIVE)
(760) 946-8195
Entity
Organization
Contact information
Practice address
18077 US HIGHWAY 18, APPLE VALLEY, CA 92307-2150
(760) 946-8169
(760) 946-8875
Mailing address
18300 US HIGHWAY 18, APPLE VALLEY, CA 92307-2206
(760) 242-2311
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
NMW1225
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GNMW00060
MEDICAL
CA
Enumeration date
09/19/2007
Last updated
12/16/2020
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