1194877332 NPI number — DIGNITY HEALTH

Table of content: (NPI 1194877332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194877332 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:
1194877332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2013
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:
805-389-5800
Provider Business Mailing Address Fax Number:
805-383-7460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2309 ANTONIO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-389-5632
Provider Business Practice Location Address Fax Number:
805-383-7450
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAURICE
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
805-988-2500

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  050000048 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 050000048 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HSP30616I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51406 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC30616I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40616I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA5606Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870692236930100000 . This is a "WPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: LTC70024G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870692236 . This is a "IRS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870692236930100002 . This is a "WPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870692236B . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: LTC55223G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com