Healthcare Provider Details

I. General information

NPI: 1962790014
Provider Name (Legal Business Name): DIGNITY HEALTH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST STE 302
SAN FRANCISCO CA
94117-1078
US

IV. Provider business mailing address

PO BOX 742824
LOS ANGELES CA
90074-2824
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5995
  • Fax: 415-666-3144
Mailing address:
  • Phone: 916-379-2912
  • Fax: 916-859-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
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