# PROVIDENCE MEDICAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St Jude Hospital Yorba Linda, St Joseph Heritage Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285890624
- **Authorized official:** DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1514 VALLEY VISTA DR, DIAMOND BAR, CA 91765-3929
- **Practice address phone:** (909) 860-1144
- **Practice address fax:** (909) 860-8307
- **Mailing address:** PO BOX 31001 - 1920, PASADENA, CA 91110-1920
- **Mailing address phone:** (714) 449-4800
- **Mailing address fax:** (714) 449-4956

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/05/2008
- **Last updated:** 02/03/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CG4895 | RAILROAD MEDICARE PROVIDER NUMBER | CA |