Healthcare Provider Details

I. General information

NPI: 1730041211
Provider Name (Legal Business Name): LA MESA FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 LA MESA BLVD STE 200
LA MESA CA
91942-0966
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2585
  • Fax: 619-269-0198
Mailing address:
  • Phone: 619-515-2300
  • Fax: 619-237-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RICARDO ROMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 619-906-4603