# PROVIDENCE MEDICAL FOUNDATION

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

## Provider details

- **NPI number:** 1316243769
- **Authorized official:** DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 2141 N HARBOR BLVD STE 35000, FULLERTON, CA 92835
- **Practice address phone:** (714) 626-8630
- **Practice address fax:** (714) 626-8659
- **Mailing address:** PO BOX 31001 - 1920, PASADENA, CA 91110-1920

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 02/02/2011
- **Last updated:** 02/03/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6852510002 | NSC | CA |