# PROVIDENCE HEALTHCARE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760984033
- **Authorized official:** DEAN MATSUDA MD (PRESIDENT)
- **Authorized official phone:** (310) 963-0994

## Contact information

- **Practice address:** 13160 MINDANAO WAY, MARINA DEL REY, CA 90292-6358
- **Practice address phone:** (310) 437-7923
- **Practice address fax:** (310) 561-1927
- **Mailing address:** 214 MAIN ST, EL SEGUNDO, CA 90245-3803
- **Mailing address phone:** (310) 322-4278
- **Mailing address fax:** (310) 570-2231

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G056259 | CA | Yes |

## Other

- **Enumeration date:** 03/02/2018
- **Last updated:** 03/02/2018