PROVIDENCE MEDICAL FOUNDATION NPI 1053616706

NPI Information

  • NPI: 1053616706
  • Provider Name: PROVIDENCE MEDICAL FOUNDATION
  • Classification: Urology - 208800000X
  • Entity Type: Organization
  • :
  • CLIA Number: 05D2283520
  • Address: 19333 BEAR VALLEY RD
    SUITE 106
    APPLE VALLEY, CA
    ZIP 92308
  • Phone: (760) 240-5505

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NPI Details

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 .

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 3/17/2025.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrologyYes
2261QR0200XClinic/CenterRadiologyNo
3332B00000XDurable Medical Equipment & Medical SuppliesNo

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: 3/30/2025

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