Organization
FAMILY HEALTH CENTERS OF SAN DIEGO, INC
Active
Other names
KidCare Express
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
090000612
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC70978F
—
CA
01
—
W5352A
MEDICARE - NHIC
CA
Enumeration date
07/05/2006
Last updated
02/19/2024
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