Healthcare Provider Details

I. General information

NPI: 1386937977
Provider Name (Legal Business Name): DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 VERDUGO WAY STE 100
CAMARILLO CA
93012-8681
US

IV. Provider business mailing address

PO BOX 742063
LOS ANGELES CA
90074-2063
US

V. Phone/Fax

Practice location:
  • Phone: 805-384-8071
  • Fax: 805-987-1927
Mailing address:
  • Phone: 916-379-2912
  • Fax: 916-859-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty 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