Providence Medical Foundation

NPI #1053616706 in Apple Valley, California

Provider Information

NPI Number: 1053616706
Entity Type: Organization
Organization Name: Providence Medical Foundation
Primary Specialty: Urology
Enumeration Date: Jan 11, 2011
Last Updated: Dec 1, 2025

Practice Location

Address: 19333 BEAR VALLEY RD
Address 2: SUITE 106
City: Apple Valley
State: California
ZIP Code: 92308-5148
Phone: (760) 240-5505

Authorized Official

Name: DONALD W. ANDERSON JR.
Title: ASSISTANT SECRETARY OF ENROLLMENTS
Phone: (425) 358-9786

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Radiology — Radiology	261QR0200X
Durable Medical Equipment & Medical Supplies	332B00000X
Urology	208800000X	Primary

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