Healthcare Provider Details

I. General information

NPI: 1508801069
Provider Name (Legal Business Name): FAMILY HEALTH CENTERS OF SAN DIEGO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8788 JAMACHA RD
SPRING VALLEY CA
91977-4035
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2555
  • Fax: 619-462-5584
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 Number090000593
License Number StateCA

VIII. Authorized Official

Name: RICARDO ROMAN
Title or Position: CFO
Credential:
Phone: 619-515-2300