MEDICARE: FAMILY HEALTH CENTERS OF SAN DIEGO, INC

Medicare Provider Information

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)	090000469	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	W5352A	OTHER	CA	MEDICARE PART B

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CGP162351	OTHER	CA	GHPP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1700821303
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	:	3544 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4120
Country	:	US
Telephone Number	:	619-515-2424
Fax Number	:	619-683-7570

Authorized Official
Title or Position	:	CFO
Name	:	MR. RICARDO ROMAN
Credential	:
Telephone Number	:	619-906-4603

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	02/19/2024

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

3544 30TH ST
SAN DIEGO, CA
92104-4120