PROVIDENCE MEDICAL FOUNDATION NPI 1871607762

NPI Information

PROVIDENCE MEDICAL FOUNDATION is a family medicine in Brea, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PROVIDENCE MEDICAL FOUNDATION NPI is 1871607762. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is St Joseph Heritage Healthcare.

The provider's business location address is:

955 W IMPERIAL HWY STE 110
BREA, CA
ZIP 92821-814
Phone: (714) 449-4900

The provider's authorized official is Jill A Duplechan .
The authorized official title is Chief Administrative Officer and has the following contact phone number (714) 347-7790.

The CLIA number assigned to this NPI record is 05D0962699 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/18/2006 and was last updated on 5/13/2021.

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:

Other Identifiers

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