Organization
PROVIDENCE HEALTHCARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN MATSUDA MD (PRESIDENT)
(310) 963-0994
Entity
Organization
Contact information
Practice address
13160 MINDANAO WAY, MARINA DEL REY, CA 90292-6358
(310) 437-7923
(310) 561-1927
Mailing address
214 MAIN ST, EL SEGUNDO, CA 90245-3803
(310) 322-4278
(310) 570-2231
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G056259
CA
Other
Enumeration date
03/02/2018
Last updated
03/02/2018
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