1346480837 NPI number — FAMILY HEALTH CENTERS OF SAN DIEGO, INC

Table of content: (NPI 1346480837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346480837 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:
CHULA VISTA FAMILY HEALTH CENTER
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:
1346480837
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:
251 LANDIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-2628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2500
Provider Business Practice Location Address Fax Number:
619-934-9578
Provider Enumeration Date:
02/24/2009

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  550000877 , 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)

  • Identifier: 550000877 . This is a "LICENSE - STATE OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".