# PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ONE MEDICAL, ONE MEDICAL WITH PROVIDENCE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518438712
- **Authorized official:** MR. DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
- **Authorized official phone:** (425) 525-5392

## Contact information

- **Practice address:** 2020 SANTA MONICA BLVD STE 300, SANTA MONICA, CA 90404-2013
- **Practice address phone:** (310) 582-7312
- **Mailing address:** 2020 SANTA MONICA BLVD STE 300, SANTA MONICA, CA 90404-2013
- **Mailing address phone:** (310) 582-7312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 12/16/2018
- **Last updated:** 02/07/2019