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Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Other names
St Joseph Heritage Healthcare
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
500 DOYLE PARK DR, SUITE 303, SANTA ROSA, CA 95405-4558
(707) 303-8300
(707) 303-8301
Mailing address
PO BOX 31001 - 1920, PASADENA, CA 91110-1920
(714) 449-4800
(714) 449-4956
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
01/10/2011
Last updated
12/03/2025
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