Healthcare Provider Details

I. General information

NPI: 1013194323
Provider Name (Legal Business Name): NMA COMPREHENSIVE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 OCEAN VIEW BLVD
SAN DIEGO CA
92113-1432
US

IV. Provider business mailing address

446 26TH ST SUITE 101
SAN DIEGO CA
92102-3026
US

V. Phone/Fax

Practice location:
  • Phone: 619-231-9300
  • Fax: 619-232-5922
Mailing address:
  • Phone: 619-231-3200
  • Fax: 619-231-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number090000143
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number090000143
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL H OWENS
Title or Position: CEO & CMO
Credential: MD, MPH, FACPE, CPE
Phone: 619-231-3200