PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA (NPI# 1942247291) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942247291 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA |
| Other Organization Name | PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO |
| Practice Address |
1300 W 7th St San Pedro CA 90732-3505 |
| Mailing Address |
Po Box 2335 Spokane WA 99210-2335 |
| Practice Telephone | 3103037496 |
| Practice Fax Number | 3103037575 |
| Mailing Telephone | 3103037496 |
| Mailing Fax Number | 3103037575 |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | MR. DONALD WAYNE ANDERSON JR. (ASST SEC FOR ENROLLMENT/DIR REIMB) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | ========= | CA | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE CROSS PROV NUMBER | 050078 | 01 |
| CA | ZZT30078G | 05 | |
| CA | ZZT40078G | 05 | |
| CA | HSC30078G | 05 | |
| CA | HSD30078G | 05 | |
| CA | BLUE SHIELD PROV NUMBER | ZZZA1925Z | 01 |
| Other Name | Type Code |
|---|---|
| Prov Little Co of Mary San Pedro | Other Name - Individual/Organization |
| Providence Little Company of Mary Medical Center San Pedro | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1386 W 7th St # A, San Pedro, CA 907323517 | 3102414330 | 3102414342 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497241541 | Providence Health System - Southern California | Community/Behavioral Health | 1386 W 7th St # A, San Pedro, CA 90732-3517 | 2018-07-02 |
| 1477647444 | Providence Health System - Southern California | Skilled Nursing Facility | 10425 Magnolia Blvd, North Hollywood, CA 91601-4109 | 2006-10-03 |
| 1770639809 | Providence Health System - Southern California | Skilled Nursing Facility | 1322 W 6th St, San Pedro, CA 90732-3501 | 2007-01-25 |
| 1700808383 | Providence Health System - Southern California | Skilled Nursing Facility | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-24 |
| 1821019514 | Providence Health System - Southern California | Rehabilitation Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-21 |
| 1902824758 | Providence Health System - Southern California | Rehabilitation Unit | 15031 Rinaldi St, Mission Hills, CA 91345-1207 | 2006-07-18 |
| 1669490819 | Providence Health System - Southern California | Rehabilitation Unit | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-17 |
| 1154349371 | Providence Health System - Southern California | Psychiatric Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-17 |
| 1750309837 | Providence Health System - Southern California | Skilled Nursing Facility | 11600 Indian Hills Rd, Building A, Mission Hills, CA 91345-1225 | 2006-07-17 |
| 1477587632 | Providence Health System - Southern California | General Acute Care Hospital | 15031 Rinaldi St, Mission Hills, CA 91345 | 2006-07-11 |
| Street Address |
1300 W 7TH ST |
| City | SAN PEDRO |
| State | CA |
| Zip Code | 90732-3505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356323828 | Jason C Kantor | Radiology | 1300 W 7th St, San Pedro, CA 90732-3505 | 2005-11-18 |
| 1598366486 | Nina Sabet-peyman, Md Inc. | Hospice, Inpatient | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-11-05 |
| 1154922185 | Melissa Louise Zankich-patalan | Nurse Practitioner | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-11-05 |
| 1063011104 | Christina Margarita Villasenor | Occupational Therapist | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-10-20 |
| 1073125480 | Peguy-emmanuelle Alva | Registered Nurse | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-08-18 |
| 1518588433 | Southern California Emergency Medical Group | Emergency Medicine | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-05-01 |
| 1033748744 | Jenna Nicole East | Speech-Language Pathologist | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-04-04 |
| 1023654555 | Susan Marie Smith | Registered Nurse | 1300 W 7th St, San Pedro, CA 90732-3505 | 2019-11-19 |
| 1477196269 | Vilma Asuma | Registered Nurse | 1300 W 7th St, San Pedro, CA 90732-3505 | 2019-10-24 |
| 1932742905 | Professional Anesthesia Associates PC | Nurse Anesthetist, Certified Registered | 1300 W 7th St, San Pedro, CA 90732-3505 | 2019-10-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538771241 | Alicia Avila | Student in an Organized Health Care Education/Training Program | 2227 Blue Butterfly Way, #7, San Pedro, CA 90732 | 2020-08-24 |
| 1619500543 | Udana Harris | Registered Nurse | 1300 West 7th Street, Obhc Unit, San Pedro, CA 90732 | 2020-02-19 |
| 1861042301 | Patricia Elaine Moses | Technician | 106 N. Western Ave Unit 102, San Pedro, CA 90732 | 2019-09-17 |
| 1629627393 | Antonio Ramon Martinez | Technician | 3141 Blue Butterfly Unit 66, San Pedro, CA 90732 | 2019-09-05 |
| 1487207700 | Victoria A. Shook, D.d.s., A Professional Corp. | Dentist | 28138 S. Western Ave., San Pedro, CA 90732 | 2019-07-17 |
| 1144566563 | Shaun E Chandran M D Inc | Orthopaedic Surgery | 1360 W 6th Street, Suite 305, San Pedro, CA 90732 | 2012-12-13 |
| 1316281280 | Jenny Luong | Physician Assistant | 1534 W. 25th St, San Pedro, CA 90732 | 2012-11-16 |
| 1033429519 | Eric M Feit Dpm Inc | Podiatrist | 1360 West 6th St., Suite 240, San Pedro, CA 90732 | 2010-10-18 |
| 1386808673 | Meysam Zaker | Dentist | 2470 S. Western Ave, San Pedro, Ca, CA 90732 | 2008-07-15 |
| 1376735340 | Francisco J. Correa, M.d., Inc | General Practice | 1350 W. 6th St, #3, San Pedro, CA 90732 | 2007-08-14 |
| Find all providers in zip 90732 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518988518 | San Pedro Peninsula Hospital | General Acute Care Hospital | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437763224 | Mola Medical Practice Inc | General Acute Care Hospital | 6906 Treasure Trl, Los Angeles, CA 90068-1838 | 2020-08-31 |
| 1497376966 | Barton Ambulatory Clinics | General Acute Care Hospital | 2170 South Ave Ste B, South Lake Tahoe, CA 96150-7026 | 2020-05-06 |
| 1346723194 | Eisenhower Medical Center | General Acute Care Hospital | 1401 North Palm Canyon Drive, Suite #202, Palm Springs, CA 92262 | 2018-09-07 |
| 1699282285 | Kern County Hospital Authority | General Acute Care Hospital | 6001 Truxtun Ave Ste 210, Bakersfield, CA 93309-0662 | 2018-01-04 |
| 1598272577 | Eisenhower Medical Center | General Acute Care Hospital | 74020 Alessandro Drive, Suite B, Palm Desert, CA 92260 | 2017-12-29 |
| 1720597511 | Children's Recovery Center 1, LLC | General Acute Care Hospital | 3777 S Bascom Ave, Campbell, CA 95008-7320 | 2017-09-25 |
| 1336668284 | Kern County Hospital Authority | General Acute Care Hospital | 2920 F St Ste B1, Bakersfield, CA 93301-1829 | 2017-09-12 |
| 1821524315 | Azadeh Salek | General Acute Care Hospital | 308 Paseo De La Playa Apt 4, Redondo Beach, CA 90277-6251 | 2017-05-03 |
| 1790210359 | Va Hospital Mather | General Acute Care Hospital | 3131 Sparrow Dr, Sacramento, CA 95834-2639 | 2017-04-20 |
| 1881127041 | Chad William Downing | General Acute Care Hospital | 28003 Via Del Agua, Laguna Niguel, CA 92677-7359 | 2017-04-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.