1528199502 NPI number — DIGNITY HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528199502 NPI number — DIGNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528199502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3215 PROSPECT PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-6017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-275-8112
Provider Business Mailing Address Fax Number:
779-803-8118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14500 SHERMAN CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91405-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-275-8112
Provider Business Practice Location Address Fax Number:
779-803-8118
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORISSETTE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
858-275-8112

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  930000169 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 930000169 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 930000169 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HSC30299J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC70143F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870692259914050000 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: NOHS . This is a "UNIVERSAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT30299J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0777367 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT40299J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA1962Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 870692259 . This is a "IRS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSM30299J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com