Provider Demographics
NPI:1306959721
Name:SAN DIEGO CENTER FOR FAMILY HEALTH
Entity type:Organization
Organization Name:SAN DIEGO CENTER FOR FAMILY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-464-1687
Mailing Address - Street 1:PO BOX 2098
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2098
Mailing Address - Country:US
Mailing Address - Phone:619-464-1687
Mailing Address - Fax:619-303-8456
Practice Address - Street 1:6280 JACKSON DR STE 8
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3436
Practice Address - Country:US
Practice Address - Phone:619-464-1608
Practice Address - Fax:619-303-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X207Q00000X
CA207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14093Medicare PIN