MEDICARE: FAMILY AND PREVENTIIVE MEDICAL CENTER

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	261Q00000X	Clinic/Center	11952	CA

General Provider Information

NPI Number	:	1932187366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY AND PREVENTIIVE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	13176 CALLE DE LOS NINOS SAN DIEGO, CA 92129
Second Line	:	1415 RIDGE BACK ROAD #4
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-0000
Country	:	US
Telephone Number	:	619-421-4257
Fax Number	:

Provider Business Practice Location Address
First Line	:	13176 CALLE DE LOS NINOS SAN DIEGO, CA 92129 2919
Second Line	:	1415 RIDGEBACK ROAD #4
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-6983
Country	:	US
Telephone Number	:	619-421-4257
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	PROF. BELEN MAYELA SARWACINSKI
Credential	:	FNP
Telephone Number	:	619-421-4257

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	09/06/2023

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