Organization
PROVIDENCE FACEY MEDICAL FOUNDATION
Active
Parent organization
FACEY MEDICAL FOUNDATION
Other names
FACEY ENDOSCOPY CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
FACEY MEDICAL FOUNDATION
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
11333 SEPULVEDA BLVD, SUITE 3200, MISSION HILLS, CA 91345-1116
(818) 837-5776
(818) 837-5810
Mailing address
FILE 50670, LOS ANGELES, CA 90074-0670
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
05/01/2012
Last updated
05/06/2025
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