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Providence Medical Foundation
General Practice Physician in Diamond Bar, California
NPI 1285890624

Providence Medical Foundation is a General Practice Physician based in Anaheim, CA. Providence Medical Foundation practices in Diamond Bar, CA. The NPI Number for Providence Medical Foundation is 1285890624 and holds a License No. (California).

The current practice location address for Providence Medical Foundation is 1514 Valley Vista Dr, Diamond Bar, CA and can be reached out via phone at 909-860-1144 and via fax at 909-860-8307.

Location: 1514 Valley Vista Dr, Diamond Bar, CA, 92805-3960
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1285890624
Provider Name
Providence Medical Foundation
Credential
Provider Entity Type
Organization
Address
1514 Valley Vista Dr, Diamond Bar, CA, 92805-3960
Phone Number
909-860-1144
Fax Number
909-860-8307
Provider Enumeration Date
08/05/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
CG4895 01 CA RAILROAD MEDICARE PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
1514 Valley Vista Dr
City
Diamond Bar
State
California
Zip
91765-3929
Phone Number
909-860-1144
Fax Number
909-860-8307
person
Provider Business Mailing Address Details
Address
1514 Valley Vista Dr
City
Diamond Bar
State
California
Zip
91765-3929
Phone Number
909-860-1144
Fax Number
909-860-8307
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
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Definition
Definition to come...
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