MEDICARE: CITY HEIGHTS PREPARATORY CHARTER SCHOOL

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1952256109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY HEIGHTS PREPARATORY CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	4260 54TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4260 54TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6009
Country	:	US
Telephone Number	:	619-795-3137
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT DIRECTOR
Name	:	MERDIN MOHAMMED
Credential	:
Telephone Number	:	619-795-3137

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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