Providence Medical Foundation
Family Medicine
955 W Imperial Hwy Ste 110, Brea
California, 92821-3814
714-449-4900 Providence Medical Foundation is a Family Medicine in Brea, California. It is located at 955 W Imperial Hwy Ste 110, Brea and it's customer support contact number is 714-449-4900. The authorized person of Providence Medical Foundation is Donald W. Anderson Jr. who is Assistant Secretary Of Enrollments of this DME and his contact number is 425-358-9786.
Providence Medical Foundation is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
DME Supplier Details:
Providence Medical Foundation type, location, contact phone number and fax are as below. Patients can directly walkin or can call on the below given customer support phone number for enquiries.
| Name: | Providence Medical Foundation |
| Type: | Family Medicine |
| Location: | 955 W Imperial Hwy Ste 110, Brea,
California, 92821-3814 |
| Phone: | 714-449-4900 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this supplier is as below. Person's position and contact details are also mentioned below.
| Name: | Donald W. Anderson Jr. |
| Position: | Assistant Secretary Of Enrollments |
| Contact Number: | 425-358-9786 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given supplier are as mentioned below.
| NPI Number: | 1871607762 |
| NPI Enumeration Date: | 18 Aug, 2006 |
| NPI Last Update On: | 03 Feb, 2026 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Providence Medical Foundation are as mentioned below.
| Specialization | License Number | State | Status | |
| Family Medicine | | | Primary | |
| Radiology | | | Secondary | |
| Obstetrics & Gynecology | | | Secondary | |
| Oxygen Equipment & Supplies | 091052001 | California | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of this supplier such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| GR0062058 | Medicaid | California | |
| LAB76828F | Medicaid | California | |
| GR0062050 | Medicaid | California | |
| GR0062051 | Medicaid | California | |
| GR0062053 | Medicaid | California | |
| GR0062056 | Medicaid | California | |
| GR0062059 | Medicaid | California | |
| GR0062057 | Medicaid | California | |
| GR006205A | Medicaid | California | |
| GR0062054 | Medicaid | California | |
| GR0062055 | Medicaid | California | |
| GR0062052 | Medicaid | California | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Po Box 31001 - 1920,
Pasadena, California |
| Zip: | 91110-1920 |
| Phone Number: | 714-449-4841 |
Patients can reach Providence Medical Foundation at
955 W Imperial Hwy Ste 110, Brea, California or can
call on customer care at 714-449-4900.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 09 March, 2026.