Healthcare Provider Details

I. General information

NPI: 1467356097
Provider Name (Legal Business Name): FAMILY HEALTH CENTERS OF SAN DIEGO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 IMPERIAL AVE STE 102
SAN DIEGO CA
92102-3826
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-255-8533
  • Fax: 619-255-8535
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 StateNULL

VIII. Authorized Official

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