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
1514 VALLEY VISTA DR, DIAMOND BAR, CA 91765-3929
(909) 860-1144
(909) 860-8307
Mailing address
PO BOX 31001 - 1920, PASADENA, CA 91110-1920
(714) 449-4800
(714) 449-4956
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG4895
RAILROAD MEDICARE PROVIDER NUMBER
CA
Enumeration date
08/05/2008
Last updated
02/03/2026
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