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)	090000565	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	W5352	OTHER	CA	MEDICARE - NHIC

Other Identifiers

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

General Provider Information

NPI Number	:	1174549232
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	:	2391 ISLAND AVENUE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-2918
Country	:	US
Telephone Number	:	619-515-2435
Fax Number	:	619-233-2621

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	02/20/2024

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