NPIMap

Providence Facey Medical Foundation

Organization Active NPI Multi-Specialty Clinic/Center · Irvine, CA

NPI 1891348447 · NPPES record last updated May 13, 2025

Key facts

NPI
1891348447
Entity type
Organization (NPI type 2)
Primary specialty
Multi-Specialty Clinic/Center 261QM1300X
Legal business name
PROVIDENCE FACEY MEDICAL FOUNDATION
Practice address
57 Prism
Irvine, CA 92618-3148
Phone
(818) 847-6881
NPI assigned
Jul 23, 2019
Organization subpart
Yes
Parent organization (as reported)
PROVIDENCE FACEY MEDICAL FOUNDATION

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 774

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 774

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031105000822 CA Part B Supplier - Clinic/Group Practice 3173436276 Receives reassigned benefits from 704 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burbank, CA; Valencia, CA; Tarzana, CA; Simi Valley, CA; Santa Clarita, CA; Porter Ranch, CA; Playa Vista, CA; Northridge, CA…

National Provider Directory

Part of
Providence Facey Medical Foundation

Locations (25 of 45)

3446 W Ball Rd
Anaheim, CA 92804
Phone (714) 821-3112

2500 E Imperial Hwy
Ste 110
Brea, CA 92821
Phone (818) 847-6833

503 S Buena Vista St
Ste 101
Burbank, CA 91505
Phone (818) 869-7630

503 S Buena Vista St
Ste 102
Burbank, CA 91505
Phone (818) 953-4430

26777 Agoura Rd
Ste B4
Calabasas, CA 91302
Phone (818) 880-2225

26777 Agoura Rd
#4
Calabasas, CA 91302
Phone (818) 880-2225

395 Carmen Dr
Camarillo, CA 93010
Phone (805) 914-5592

17909 Soledad Canyon Rd
Ste 200
Canyon Country, CA 91387
Phone (661) 250-5200

17909 Soledad Canyon Rd
Ste 102
Canyon Country, CA 91387
Phone (661) 250-5200

17909 Soledad Canyon Rd
Ste 230
Canyon Country, CA 91387
Phone (661) 250-5200

17909 Soledad Canyon Rd
Ste 220
Canyon Country, CA 91387
Phone (661) 250-5200

31882 Castaic Rd
Castaic, CA 91384
Phone (661) 775-1400

10174 Mason Ave
Chatsworth, CA 91311
Phone (818) 847-6886

24833 Del Prado
Dana Point, CA 92629
Phone (818) 847-6834

331 N Pacific Coast Hwy
El Segundo, CA 90245
Phone (310) 640-9641

1575 S Harbor Blvd
Fullerton, CA 92832
Phone (818) 847-6884

12001 Euclid St
Garden Grove, CA 92840
Phone (714) 530-1071

475 Foothill Blvd
La Canada, CA 91011
Phone (818) 528-6377

25612 Crown Valley Pkwy
Ste L-5
Ladera Ranch, CA 92694
Phone (818) 847-6812

320 W 6TH St
Los Angeles, CA 90014

8985 Venice Blvd
Ste A38
Los Angeles, CA 90034

5335 W Adams Blvd
Ste 102
Los Angeles, CA 90016
Phone (213) 513-5207

4730 Lincoln Blvd
Marina del Rey, CA 90292
Phone (424) 352-0371

15451 San Fernando Mission Blvd
Ste 300
Mission Hills, CA 91345
Phone (818) 837-5789

11333 Sepulveda Blvd
#3200
Mission Hills, CA 91345
Phone (818) 837-5779

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Yes

Addresses

Primary practice location

57 Prism
Irvine, CA 92618-3148

Mailing address

File 50670
Los Angeles, CA 90074-0670
Phone (818) 837-5637

Other names

  • PROVIDENCE EXPRESS CARE Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 13, 2025.

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1891348447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 50670",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740670",
            "telephone_number": "818-837-5637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 PRISM",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183148",
            "telephone_number": "818-847-6881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE FACEY MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE FACEY MEDICAL FOUNDATION",
        "enumeration_date": "2019-07-23",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE EXPRESS CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

All providers in Irvine, CA · Multi-Specialty Clinic/Center in California

Sources for this page

Verify at the official NPI Registry.