Healthcare Provider Details

I. General information

NPI: 1508222647
Provider Name (Legal Business Name): DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18406 ROSCOE BLVD
NORTHRIDGE CA
91325-4107
US

IV. Provider business mailing address

3400 DATA DR 1ST FLOOR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-5480
  • Fax:
Mailing address:
  • Phone: 916-379-2726
  • Fax: 916-853-7874

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