Organization
PROVIDENCE MEDICAL FOUNDATION
Active
Other names
St Joseph Heritage Healthcare, St Jude Hospital Yorba Linda
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
19333 BEAR VALLEY RD, SUITE 106, APPLE VALLEY, CA 92308-5148
(760) 240-5505
(760) 245-5525
Mailing address
PO BOX 31001 - 1920, PASADENA, CA 91110-1920
(714) 449-4800
(714) 449-4956
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
01/11/2011
Last updated
12/01/2025
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