Healthcare Provider Details

I. General information

NPI: 1932187366
Provider Name (Legal Business Name): FAMILY AND PREVENTIIVE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13176 CALLE DE LOS NINOS SAN DIEGO, CA 92129 2919 1415 RIDGEBACK ROAD #4
CHULA VISTA CA
91910-6983
US

IV. Provider business mailing address

13176 CALLE DE LOS NINOS SAN DIEGO, CA 92129 1415 RIDGE BACK ROAD #4
CHULA VISTA CA
91910-0000
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-4257
  • Fax:
Mailing address:
  • Phone: 619-421-4257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11952
License Number StateCA

VIII. Authorized Official

Name: PROF. BELEN MAYELA SARWACINSKI
Title or Position: FNP
Credential: FNP
Phone: 619-421-4257