Healthcare Provider Details

I. General information

NPI: 1053653873
Provider Name (Legal Business Name): DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E HIGHLAND AVE STE 251
SAN BERNARDINO CA
92404-3800
US

IV. Provider business mailing address

PO BOX 743260
LOS ANGELES CA
90074-3260
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-4605
  • Fax: 909-475-2680
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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