Healthcare Provider Details

I. General information

NPI: 1780807248
Provider Name (Legal Business Name): DIGNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 N CALIFORNIA ST
STOCKTON CA
95204-6031
US

IV. Provider business mailing address

1800 N CALIFORNIA ST
STOCKTON CA
95204-6019
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-6396
  • Fax: 209-467-6513
Mailing address:
  • Phone: 209-467-6396
  • Fax: 209-467-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberCA CLF2633
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCA CLF2633
License Number StateCA

VIII. Authorized Official

Name: DOREEN HARTMANN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 209-467-6442