Organization
DIGNITY HEALTH MEDICAL FOUNDATION
Active
Parent organization
DIGNITY HEALTH MEDICAL FOUNDATION
Other names
Dignity Health Medical Group - Stockton, a service of Dignity Health M
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIGNITY HEALTH MEDICAL FOUNDATION
Authorized official
THERESA M HYLEN (CHIEF FINANCIAL OFFICER)
(916) 851-2559
Entity
Organization
Contact information
Practice address
3132 W MARCH LN, SUITE 5, STOCKTON, CA 95219-2354
(209) 475-5500
(209) 475-5515
Mailing address
PO BOX 742027, LOS ANGELES, CA 90074-2027
(916) 379-2840
(916) 859-1106
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
371518341
STOCKTON LOC - IRS SP TAX
—
01
—
7291
STOCKTON LOC - HEALTHNET
—
05
—
GR0091671
—
CA
01
—
ZZZ66457Z
BLUE SHIELD
CA
Enumeration date
07/18/2006
Last updated
11/18/2020
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