# ST. MARY MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence St. Mary Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043406440
- **Authorized official:** RANDALL CASTILLO (CHIEF EXECUTIVE)
- **Authorized official phone:** (760) 946-8195

## Contact information

- **Practice address:** 18077 US HIGHWAY 18, APPLE VALLEY, CA 92307-2150
- **Practice address phone:** (760) 946-8169
- **Practice address fax:** (760) 946-8875
- **Mailing address:** 18300 US HIGHWAY 18, APPLE VALLEY, CA 92307-2206
- **Mailing address phone:** (760) 242-2311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367A00000X | Advanced Practice Midwife | NMW1225 | CA | Yes |

## Other

- **Enumeration date:** 09/19/2007
- **Last updated:** 12/16/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | GNMW00060 | MEDICAL | CA |