Provider Demographics
NPI:1154402675
Name:SAMUEL DIXON FAMILY HEALTH CENTER, INC
Entity type:Organization
Organization Name:SAMUEL DIXON FAMILY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-257-2339
Mailing Address - Street 1:25115 AVENUE STANFORD
Mailing Address - Street 2:A-104
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1290
Mailing Address - Country:US
Mailing Address - Phone:661-257-2339
Mailing Address - Fax:661-257-2384
Practice Address - Street 1:30257 SAN MARTINEZ RD
Practice Address - Street 2:
Practice Address - City:VAL VERDE
Practice Address - State:CA
Practice Address - Zip Code:91384-2472
Practice Address - Country:US
Practice Address - Phone:661-257-4008
Practice Address - Fax:661-257-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70448FMedicaid