Provider Demographics
NPI:1003084211
Name:PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
Entity Type:Organization
Organization Name:PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
Other - Org Name:PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PALLIATIVE CARE
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ISAMU
Authorized Official - Last Name:KOMATSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-303-6840
Mailing Address - Street 1:4101 TORRANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4607
Mailing Address - Country:US
Mailing Address - Phone:310-303-6840
Mailing Address - Fax:310-303-5574
Practice Address - Street 1:4101 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4607
Practice Address - Country:US
Practice Address - Phone:310-303-6840
Practice Address - Fax:310-303-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35086282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110726Medicare UPIN