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Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Other names
St Joseph Heritage Healthcare, St Jude Hospital Yorba Linda
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
2141 N HARBOR BLVD STE 35000, FULLERTON, CA 92835
(714) 626-8630
(714) 626-8659
Mailing address
PO BOX 31001 - 1920, PASADENA, CA 91110-1920
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6852510002
NSC
CA
Enumeration date
02/02/2011
Last updated
02/03/2026
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