PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA (NPI# 1154349371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154349371 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA |
| Practice Address |
1300 W 7th St San Pedro CA 90732-3505 |
| Mailing Address |
Po Box 2335 Spokane WA 99210-2335 |
| Practice Telephone | 3108323311 |
| Mailing Telephone | 3103037496 |
| Mailing Fax Number | 3103037496 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-12-24 |
| Authorized Official Name | DONALD WAYNE ANDERSON (ASSISTANT SECRETARY - ENROLLMENT) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273R00000X | Psychiatric Unit | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | HSM30078G | 05 | |
| CA | BLUE CROSS | 05S078 | 01 |
| Other Name | Type Code |
|---|---|
| Providence Little Company of Mary Medical Center San Pedro | Doing Business As Name - Organization |
| 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 |
| 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 |
| 1336173269 | Providence Health System - Southern California | General Acute Care Hospital | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-10 |
| 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 |
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| 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 | 273R00000X |
| Grouping | Hospital Units |
| Classification | Psychiatric Unit |
| In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346264801 | San Pedro Peninsula Hospital | Psychiatric Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740807643 | Pacific Health Group Inc. | Psychiatric Unit | 9120 Woodman Ave, Arleta, CA 91331-6405 | 2020-06-26 |
| 1720627979 | Ernest Markovich | Psychiatric Unit | 3235 N Hartman St, Orange, CA 92865-1216 | 2020-01-04 |
| 1316416670 | Psychiatric Excellence | Psychiatric Unit | 388 Market St Ste 1300, San Francisco, CA 94111-5316 | 2018-11-16 |
| 1982192514 | Veronica E Martinez | Psychiatric Unit | 9481 Hanford St, Ventura, CA 93004-0704 | 2018-04-30 |
| 1679008817 | Ucla Semel Institute | Psychiatric Unit | 615 6th St, Davis, CA 95616-3807 | 2017-04-25 |
| 1083152748 | Rady Childrens Hospital-san Diego | Psychiatric Unit | 4305 University Avenue, Suite 150, San Diego, CA 92105 | 2017-02-02 |
| 1871045385 | Molina Psychological Consultants | Psychiatric Unit | 18 Monrovia, Irvine, CA 92602-0925 | 2016-10-31 |
| 1457808073 | Susan Mora | Psychiatric Unit | 1239 Powell St, Apt 2, San Francisco, CA 94133-4874 | 2016-09-01 |
| 1306204342 | County of Santa Clara | Psychiatric Unit | 820 Enborg Court, San Jose, CA 95128 | 2016-02-05 |
| 1477931673 | Nigthingale Nurses | Psychiatric Unit | 350 N Magnolia St, Woodlake, CA 93286-1320 | 2015-05-08 |
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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.