PROVIDENCE MEDICAL FOUNDATION – NPI #1285890624
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

PROVIDENCE MEDICAL FOUNDATION is a provider located in DIAMOND BAR, CA. NPPES has assigned the NPI number 1285890624 to PROVIDENCE MEDICAL FOUNDATION on August 05, 2008. It is a Type-2 NPI, indicating this NPI number is associated with an organization. This provider is also associated with 2 additional names listed below. The primary taxonomy selected by this provider is 208D00000X from the Health Care Provider Taxonomy code set, which is classified as General Practice.

The NPI profile was last updated on Feb 03, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PROVIDENCE MEDICAL FOUNDATION below.

NPI Profile for
PROVIDENCE MEDICAL FOUNDATION

NPI Number
1285890624
Enumeration Date

(about 18 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PROVIDENCE MEDICAL FOUNDATION
Other name(s)
All associated names:
Former Legal Business Name
St Joseph Heritage Healthcare
Former Legal Business Name
St Jude Hospital Yorba Linda
Primary location
1514 VALLEY VISTA DR
DIAMOND BAR, CA 91765-3929
Phone: (909) 860-1144 Fax: (909) 860-8307
Mailing address
PO BOX 31001 - 1920
PASADENA, CA 91110-1920
Phone: (714) 449-4800 Fax: (714) 449-4956
Organization Subpart
No
Authorized Official
DONALD ANDERSON
ASSISTANT SECRETARY OF ENROLLMENTS
Phone: (425) 358-9786
Updated
Certification Date
Feb 03, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for PROVIDENCE MEDICAL FOUNDATION

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherRAILROAD MEDICARE PROVIDER NUMBERCACG4895
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
208D00000X
- General Practice (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.