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PROVIDENCE HEALTHCARE INC NPI 1760984033


NPI Information

NPI: 1760984033
Provider Name: PROVIDENCE HEALTHCARE INC
Classification: Orthopaedic Surgery - 207X00000X
Entity Type: Organization

CLIA Number: 05D2142176

Address:
13160 MINDANAO WAY
MARINA DEL REY, CA
ZIP 90292
Phone: (310) 437-7923
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PROVIDENCE HEALTHCARE INC is an orthopaedic surgery in Marina Del Rey, CA. The provider is an orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. PROVIDENCE HEALTHCARE INC NPI is 1760984033. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

13160 MINDANAO WAY
MARINA DEL REY, CA
ZIP 90292-358
Phone: (310) 437-7923
Fax: (310) 561-1927

The provider's authorized official is Dean Matsuda .
The authorized official title is President and has the following contact phone number (310) 963-0994.

The CLIA number assigned to this NPI record is 05D2142176 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/2/2018 and was last updated on 3/2/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207X00000XOrthopaedic SurgeryG056259CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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