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NPI Code Detail

MEDICARE: DIGNITY HEALTH MEDICAL FOUNDATION

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
1261QM1300XMulti-Specialty Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2ZZZ50290ZOTHERBSCA

General Provider Information

NPI Number : 1699971333
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIGNITY HEALTH MEDICAL FOUNDATION
Provider Business Mailing Address
First Line : 3160 FOLSOM BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-5219
Country : US
Telephone Number : 916-733-5701
Fax Number : 916-733-3401
Provider Business Practice Location Address
First Line : 13350 BIG BASIN WAY
Second Line :
City : BOULDER CREEK
State : CA
Zip : 95006-9237
Country : US
Telephone Number : 831-338-2767
Fax Number : 831-338-2767
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : THERESA M HYLEN
Credential :
Telephone Number : 916-851-2559
Provider Enumeration Date : 06/21/2007
Last Update Date : 11/18/2020

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Directions to “DIGNITY HEALTH MEDICAL FOUNDATION ” Practice Location

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