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Organization
PROVIDENCE MEDICAL INSTITUTE
Active
Organization
PROVIDENCE MEDICAL INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD WAYNE ANDERSON (ASSISTANT SECRETARY-ENROLLMENT)
(425) 525-5392
Entity
Organization
Contact information
Practice address
4101 TORRANCE BLVD, TORRANCE, CA 90503-4607
(310) 303-6833
Mailing address
21311 MADRONA AVE STE 101, TORRANCE, CA 90503-5970
(310) 792-4015
(310) 792-4093
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
CA
Other
Enumeration date
09/04/2018
Last updated
09/04/2018
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