Organization
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Active
Organization
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Active
Other names
KidCare Express III
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICARDO ROMAN (CFO)
(619) 515-2300
Entity
Organization
Contact information
Practice address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 515-2300
(619) 237-1856
Mailing address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 515-2300
(619) 237-1856
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550000018
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051054
MEDICARE PTAN
CA
Enumeration date
08/04/2014
Last updated
02/20/2024
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