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Organization
ST JUDE HOSPITAL YORBA LINDA
Active
Organization
ST JUDE HOSPITAL YORBA LINDA
Active
Other names
ST JUDE HERITAGE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN C BENNETT (VICE PRESIDENT)
(714) 578-8586
Entity
Organization
Contact information
Practice address
279 IMPERIAL HWY, SUITE 730, FULLERTON, CA 92835-1041
(714) 449-4800
(714) 449-4956
Mailing address
DEPT LA 21190, PASADENA, CA 91185-0001
(714) 449-4800
(714) 449-4956
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
208200000X
Plastic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
208M00000X
Hospitalist Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
08/18/2008
Last updated
08/18/2008
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