Healthcare Provider Details

I. General information

NPI: 1003902917
Provider Name (Legal Business Name): SAN DIEGO AMERICAN INDIAN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 1ST AVE
SAN DIEGO CA
92103-6599
US

IV. Provider business mailing address

2630 1ST AVE
SAN DIEGO CA
92103-6599
US

V. Phone/Fax

Practice location:
  • Phone: 619-234-2158
  • Fax: 619-234-0206
Mailing address:
  • Phone: 619-234-2158
  • Fax: 619-234-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS17413
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number57514
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58278
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG23820A
License Number StateCA
# 12
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA78887
License Number StateCA
# 13
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA107921
License Number StateCA
# 14
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20936
License Number StateCA

VIII. Authorized Official

Name: MR. TAMI BEREKI
Title or Position: CFO
Credential:
Phone: 909-921-3808