Providence Healthcare Inc

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

G056259 Issued in CA

Legal business name

PROVIDENCE HEALTHCARE INC

Practice address

13160 Mindanao Way
Marina del Rey, CA 90292-6358

Phone

(310) 437-7923

Fax

(310) 561-1927

NPI assigned

Mar 2, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dean Matsuda, MD

Title

President

Phone

(310) 963-0994

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519948800000",
    "number": "1760984033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 MAIN ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453803",
            "telephone_number": "310-322-4278",
            "fax_number": "310-570-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13160 MINDANAO WAY",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926358",
            "telephone_number": "310-437-7923",
            "fax_number": "310-561-1927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-02",
        "last_updated": "2018-03-02",
        "status": "A",
        "authorized_official_last_name": "MATSUDA",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-963-0994",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G056259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.