| Providence Medical Foundation | |
|
200 W Center Street Promenade Anaheim CA 92805-3960 | |
| (147) 123-5007 | |
| Not Available |
| Full Name | Providence Medical Foundation |
|---|---|
| Speciality | Family Medicine |
| Location | 200 W Center Street Promenade, Anaheim, 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) 449-4800 | Providence Medical Foundation 200 W Center Street Promenade Anaheim CA 92805-3960 Ph: (147) 123-5007 |
| NPI Number | 1639715709 |
|---|---|
| Provider Enumeration Date | 11/22/2019 |
| Last Update Date | 05/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639715709 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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