PROVIDENCE MEDICAL FOUNDATION NPI 1871607762

NPI Information

  • NPI: 1871607762
  • Provider Name: PROVIDENCE MEDICAL FOUNDATION
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • :
  • CLIA Number: 05D2251795
  • Address: 955 W IMPERIAL HWY STE 110
    BREA, CA
    ZIP 92821
  • Phone: (714) 449-4900

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NPI Details

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 .

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 05D2251795 - 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 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
1207Q00000XFamily MedicineYes
2207V00000XObstetrics & GynecologyNo
3261QR0200XClinic/CenterRadiologyNo
4332BX2000XDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies091052001CALIFORNIANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GR0062058MEDICAIDCALIFORNIA
2LAB76828FMEDICAIDCALIFORNIA
3GR0062050MEDICAIDCALIFORNIA
4GR0062051MEDICAIDCALIFORNIA
5GR0062053MEDICAIDCALIFORNIA
6GR0062056MEDICAIDCALIFORNIA
7GR0062059MEDICAIDCALIFORNIA
8GR0062057MEDICAIDCALIFORNIA
9GR006205AMEDICAIDCALIFORNIA
10GR0062054MEDICAIDCALIFORNIA
11GR0062055MEDICAIDCALIFORNIA
12GR0062052MEDICAIDCALIFORNIA

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: 11/21/2025

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