Basic Information
| Provider Information | |||||||||
| NPI: | 1679019798 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIGNITY HEALTH MEDICAL FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6615 VALLEY HI DR | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958237076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164502600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6615 VALLEY HI DR | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958237076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164502600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2017 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | HYLEN | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9168512559 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 1041SO200X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.