ST. VINCENT DE PAUL VILLAGE INC NPI 1659415131

NPI Information

ST. VINCENT DE PAUL VILLAGE, INC is a federally qualified health center (fqhc) clinic center in San Diego, CA. ST. VINCENT DE PAUL VILLAGE, INC NPI is 1659415131. The provider is registered as an organization entity type.
The provider Other Name Is St. Vincent De Paul Village Family Health Center.

The provider's business location address is:

1501 IMPERIAL AVE
SAN DIEGO, CA
ZIP 92101-638
Phone: (619) 233-8500
Fax: (619) 645-6470

The provider's authorized official is Melinda Mallie .
The authorized official title is Chief Financial Officer and has the following contact phone number (619) 446-2194.

The CLIA number assigned to this NPI record is 05D0941891 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/16/2007 and was last updated on 2/22/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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