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
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1073267118
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	:	1625 NEWTON AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-1012
Country	:	US
Telephone Number	:	619-515-2312
Fax Number	:	619-702-8536

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	RICARDO ROMAN
Credential	:
Telephone Number	:	619-515-2300

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	02/20/2024

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