SAN DIEGO FAMILY CARE NPI 1962483040

NPI Information

NPI: 1962483040
Provider Name: SAN DIEGO FAMILY CARE

Doing Business As: MID-CITY COMMUNITY CLINIC-PEDIATRICS

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
4305 UNIVERISTY AVE
SUITE 150
SAN DIEGO, CA
ZIP 92105
Phone: (619) 563-0507
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SAN DIEGO FAMILY CARE is a federally qualified health center (fqhc) clinic center in San Diego, CA. SAN DIEGO FAMILY CARE NPI is 1962483040. The provider is registered as an organization entity type.
The provider Is Doing Business As Mid-city Community Clinic-pediatrics.

The provider's business location address is:

4305 UNIVERISTY AVE
SUITE 150
SAN DIEGO, CA
ZIP 92105-690
Phone: (619) 563-0507
Fax: (619) 563-0015

The provider's authorized official is Roberta Lee Feinberg .
The authorized official title is Chief Executive Officer and has the following contact phone number (619) 563-0507.

The CLIA number assigned to this NPI record is 05D0569878 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/7/2005 and was last updated on 8/22/2020.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

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

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	EAP11672F	OTHER	CALIFORNIA	EXPANDED ACESS TO PRIMARY
2	FHC71000G	OTHER	CALIFORNIA	MEDI CAL FQHC
3	80406	OTHER	CALIFORNIA	HEALTHY FAMILIES
4	FHC71000G	OTHER	CALIFORNIA	CHDP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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