1184169963 NPI number — FAMILY HEALTH CENTERS OF SAN DIEGO, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184169963 NPI number — FAMILY HEALTH CENTERS OF SAN DIEGO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH PARK FAMILY HEALTH CENTER II
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184169963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
823 GATEWAY CENTER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92102-4541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-515-2300
Provider Business Mailing Address Fax Number:
619-237-1856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3514 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2424
Provider Business Practice Location Address Fax Number:
619-683-7586
Provider Enumeration Date:
01/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ROMAN
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
619-515-2300

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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