1073665360 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 1073665360 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:
1073665360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2415 ANTONIO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010-1459
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:
1600 N ROSE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030-3722
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:
01/17/2007

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: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: 050000064 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 050000064 , 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: ZZT40082G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZC5602Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651191373 . This is a "IRS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050082B000000 . This is a "TRAILBLAZERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651191373930300000 . This is a "WPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651191373930300002 . This is a "WPS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC30082G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30082G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62660 . This is a "AENTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651191373E . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".




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