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NPI Code Detail

MEDICARE: FAMILY HEALTH CENTERS OF SAN DIEGO, INC

MEDICARE: FAMILY HEALTH CENTERS OF SAN DIEGO, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)090000677CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W5352FOTHERCAMEDICARE - NHIC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023054004
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY HEALTH CENTERS OF SAN DIEGO, INC
Provider Business Mailing Address
First Line : 823 GATEWAY CENTER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4541
Country : US
Telephone Number : 619-515-2300
Fax Number : 619-237-1856
Provider Business Practice Location Address
First Line : 5454 EL CAJON BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-3621
Country : US
Telephone Number : 619-515-2400
Fax Number : 619-795-2756
Authorized Official
Title or Position : CFO
Name : MR. RICARDO ROMAN
Credential :
Telephone Number : 619-515-2300
Provider Enumeration Date : 06/20/2006
Last Update Date : 02/20/2024

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Directions to “FAMILY HEALTH CENTERS OF SAN DIEGO, INC ” Practice Location

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