Basic Information
| Provider Information | |||||||||
| NPI: | 1679958037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROVIDENCE ST JOHNS HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 SANTA MONICA BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108298317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2121 SANTA MONICA BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108298317 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2015 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | O'DAY | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL ONCOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 3108298317 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | A53519 | CA | Y | Hospitals | Long Term Care Hospital |
No ID Information.