Healthcare Provider Details

I. General information

NPI: 1548566136
Provider Name (Legal Business Name): DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 SOQUEL DR SUITE 100
APTOS CA
95003-4135
US

IV. Provider business mailing address

3000 Q ST 1ST FLOOR
SACRAMENTO CA
95816-7058
US

V. Phone/Fax

Practice location:
  • Phone: 831-535-1560
  • Fax: 831-535-1568
Mailing address:
  • Phone: 916-733-3411
  • Fax: 916-853-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: THERESA M HYLEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 916-851-2559