PROVIDENCE MEDICAL FOUNDATION is an urology in Apple Valley, CA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. PROVIDENCE MEDICAL FOUNDATION NPI is 1053616706. 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:
19333 BEAR VALLEY RD
SUITE 106
APPLE VALLEY, CA
ZIP 92308-148
Phone: (760) 240-5505
Fax: (760) 245-5525
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 05D2283520 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 1/11/2011 and was last updated on 5/5/2021.