Healthcare Provider Details

I. General information

NPI: 1174531859
Provider Name (Legal Business Name): DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SHOREWAY RD SUITE 100
BELMONT CA
94002-4151
US

IV. Provider business mailing address

PO BOX 742852
LOS ANGELES CA
90074-2852
US

V. Phone/Fax

Practice location:
  • Phone: 650-596-7000
  • Fax:
Mailing address:
  • Phone: 916-379-2840
  • Fax: 916-859-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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