Healthcare Provider Details

I. General information

NPI: 1619092046
Provider Name (Legal Business Name): DIGNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE
LONG BEACH CA
90813-3271
US

IV. Provider business mailing address

1043 ELM AVE SUITE 300
LONG BEACH CA
90813-3271
US

V. Phone/Fax

Practice location:
  • Phone: 562-624-4900
  • Fax: 562-491-9128
Mailing address:
  • Phone: 562-624-4906
  • Fax: 562-624-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number930000012
License Number StateCA

VIII. Authorized Official

Name: RACHEL SMITH
Title or Position: CHIEF FINANCIAL OFFICER (INTERIM)
Credential:
Phone: 562-491-9929