Organization
DIGNITY HEALTH
Active
Organization
DIGNITY HEALTH
Active
Parent organization
DIGNITY HEALTH
Other names
St. John's Pleasant Valley Hospital Outpatient Lab
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIGNITY HEALTH
Authorized official
ROBERT WARDWELL (CHIEF FINANCIAL OFFICER)
(805) 389-5113
Entity
Organization
Contact information
Practice address
2309 ANTONIO AVE, CAMARILLO, CA 93010-1414
(805) 389-5880
(805) 389-5883
Mailing address
2415 ANTONIO AVE, CAMARILLO, CA 93010-1459
(805) 389-5115
(805) 383-7461
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 2581
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51406
AETNA
—
01
—
870692236930100000
WPS/TRICARE - GENERAL ACUTE
—
01
—
870692236930100002
WPS/TRICARE - SNF
—
01
—
870692236B
HEALTH NET
—
05
—
HSP40616I
—
CA
01
—
ZZZA5606Z
BSCA
—
Enumeration date
06/04/2008
Last updated
09/23/2013
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