Organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Active
Other names
Providence Little Company of Mary Medical Center San Pedro, Prov Little Co of Mary San Pedro
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 303-7496
(310) 303-7575
Mailing address
PO BOX 2335, SPOKANE, WA 99210-2335
(310) 303-7496
(310) 303-7575
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050078
BLUE CROSS PROV NUMBER
CA
05
—
HSC30078G
—
CA
05
—
HSD30078G
—
CA
05
—
ZZT30078G
—
CA
05
—
ZZT40078G
—
CA
01
—
ZZZA1925Z
BLUE SHIELD PROV NUMBER
CA
Enumeration date
06/02/2006
Last updated
05/09/2025
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