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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