1942247291 NPI number — PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA

Table of content: DR. MARK E. VENES D.C. (NPI 1255417135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942247291 NPI number — PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942247291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99210-2335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-303-7496
Provider Business Mailing Address Fax Number:
310-303-7575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-303-7496
Provider Business Practice Location Address Fax Number:
310-303-7575
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
ASSISTANT SECRETARY ENROLLMENTS
Authorized Official Telephone Number:
425-358-9786

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HSC30078G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30078G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA1925Z . This is a "BLUE SHIELD PROV NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT40078G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050078 . This is a "BLUE CROSS PROV NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSD30078G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com