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Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Other names
Providence Medical Group Northern California
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
185 SOTOYOME ST, SANTA ROSA, CA 95405-4803
(707) 303-8355
(707) 303-2035
Mailing address
PO BOX 31001 - 1920, PASADENA, CA 91110-1920
(707) 303-8355
(707) 303-2035
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/30/2021
Last updated
01/06/2026
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