MEDICARE: CHICAGO CLINICA MEDICA FAMILIAR OPERATED BY NEIGHBORHOOD HEALTHCARE

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	:	1760098503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO CLINICA MEDICA FAMILIAR OPERATED BY NEIGHBORHOOD HEALTHCARE

Provider Business Mailing Address
First Line	:	425 N DATE ST
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3413
Country	:	US
Telephone Number	:	760-520-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4022 CHICAGO AVE STE A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5340
Country	:	US
Telephone Number	:	760-520-8300
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RAKESH PATEL
Credential	:	MD
Telephone Number	:	760-520-8300

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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