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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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)090000113CA
2261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1164671749
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 : 2130 NATIONAL AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-2209
Country : US
Telephone Number : 619-255-5171
Fax Number : 619-269-0464
Authorized Official
Title or Position : CFO
Name : MS. RICARDO ROMAN
Credential :
Telephone Number : 619-515-2300
Provider Enumeration Date : 09/18/2008
Last Update Date : 08/28/2024

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