MEDICARE: DIGNITY HEALTH MEDICAL FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1053653873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGNITY HEALTH MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 743260
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-3260
Country	:	US
Telephone Number	:	916-379-2726
Fax Number	:	916-853-7874

Provider Business Practice Location Address
First Line	:	4240 HIGHLAND AVE
Second Line	:	SUITE B
City	:	HIGHLAND
State	:	CA
Zip	:	92346-2764
Country	:	US
Telephone Number	:	805-383-5258
Fax Number	:	805-614-5901

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	THERESA M HYLEN
Credential	:
Telephone Number	:	916-851-2559

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	11/18/2020

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