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Organization
PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION
Active
Organization
PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION
Active
Other names
ONE MEDICAL, ONE MEDICAL WITH PROVIDENCE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
(425) 525-5392
Entity
Organization
Contact information
Practice address
2020 SANTA MONICA BLVD STE 300, SANTA MONICA, CA 90404-2013
(310) 582-7312
Mailing address
2020 SANTA MONICA BLVD STE 300, SANTA MONICA, CA 90404-2013
(310) 582-7312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
12/16/2018
Last updated
02/07/2019
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