Providence Health System - Southern California
Psychiatric Unit in San Pedro, CA. Organization (NPI-2).
NPI number1154349371
StatusActive
Last updated in NPPESMay 8, 2025
Details
- NPI
- 1154349371
- Entity type
- Organization (NPI-2)
- Legal business name
- Providence Health System - Southern California
- Organization subpart
- Yes
- Enumeration date
- Jul 17, 2006
- Certification date
- May 8, 2025
- Last updated
- May 8, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 273R00000X | Psychiatric Unit | – | – | Yes |
Practice location
1300 W 7th StSan Pedro, CA 90732-3505
Phone 310-832-3311
Mailing address
Po Box 31001-3017Pasadena, CA 91110-3017
Phone 310-303-7496 · Fax 310-303-7496
Authorized official
Donald Wayne Anderson
Assistant Secretary Of Enrollments
4253589786
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