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Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Other names
St Jude Hospital Yorba Linda, 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
955 W IMPERIAL HWY STE 110, BREA, CA 92821-3814
(714) 449-4900
Mailing address
PO BOX 31001 - 1920, PASADENA, CA 91110-1920
(714) 449-4841
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
261QR0200X
Radiology Clinic/Center
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
091052001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0062050
—
CA
05
—
GR0062051
—
CA
05
—
GR0062052
—
CA
05
—
GR0062053
—
CA
05
—
GR0062054
—
CA
05
—
GR0062055
—
CA
05
—
GR0062056
—
CA
05
—
GR0062057
—
CA
05
—
GR0062058
—
CA
05
—
GR0062059
—
CA
05
—
GR006205A
—
CA
05
—
LAB76828F
—
CA
Enumeration date
08/18/2006
Last updated
02/03/2026
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