Organization
PROVIDENCE FACEY MEDICAL FOUNDATION
Active
Organization
PROVIDENCE FACEY MEDICAL FOUNDATION
Active
Parent organization
PROVIDENCE FACEY MEDICAL FOUNDATION
Other names
PROVIDENCE EXPRESS CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE FACEY MEDICAL FOUNDATION
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
57 PRISM, IRVINE, CA 92618-3148
(818) 847-6881
Mailing address
FILE 50670, LOS ANGELES, CA 90074-0670
(818) 837-5637
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/23/2019
Last updated
05/13/2025
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