| Providence Medical Foundation | |
|
955 W Imperial Hwy Ste 110 Brea CA 92821-3814 | |
| (714) 449-4900 | |
| Not Available |
| Full Name | Providence Medical Foundation |
|---|---|
| Speciality | Family Medicine |
| Location | 955 W Imperial Hwy Ste 110, Brea, California |
| Authorized Official Name and Position | Jill A Duplechan (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 7143477790 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Foundation 200 W Center Street Promenade Ste 300 Anaheim CA 92805-3960 Ph: (714) 449-4841 | Providence Medical Foundation 955 W Imperial Hwy Ste 110 Brea CA 92821-3814 Ph: (714) 449-4900 |
| NPI Number | 1871607762 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 05/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871607762 | NPI | - | NPPES |
| GR0062054 | Medicaid | CA | |
| GR0062057 | Medicaid | CA | |
| GR0062056 | Medicaid | CA | |
| GR0062055 | Medicaid | CA | |
| GR006205A | Medicaid | CA | |
| GR0062053 | Medicaid | CA | |
| LAB76828F | Medicaid | CA | |
| GR0062050 | Medicaid | CA | |
| GR0062052 | Medicaid | CA | |
| GR0062058 | Medicaid | CA | |
| GR0062051 | Medicaid | CA | |
| GR0062059 | Medicaid | CA |
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