Organization
SAN DIEGO FAMILY CARE
Active
Parent organization
SAN DIEGO FAMILY CARE
Other names
Mid-City Community Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAN DIEGO FAMILY CARE
Authorized official
MS. ROBERTA LEE FEINBERG MS (CHIEF EXECUTIVE OFFICER)
(619) 563-0507
Entity
Organization
Contact information
Practice address
4290 POLK AVE, SAN DIEGO, CA 92105-1524
(619) 563-0507
(619) 563-0015
Mailing address
4290 POLK AVE, SAN DIEGO, CA 92105-1524
(619) 563-0507
(619) 563-0015
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80406
HEALTHY FAMILIES
CA
01
—
BCP 11882 F
BCP
CA
01
—
EAP 11672 F
EXPANDED ACCESS TO PRIMAR
CA
01
—
FHC 11882 G
MEDI-CAL (FQHC)
CA
01
—
HAP 11882 G
SOFP
CA
01
—
W815
OTHER
CA
Enumeration date
11/08/2005
Last updated
07/23/2007
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