Provider Demographics
NPI:1962483040
Name:SAN DIEGO FAMILY CARE
Entity type:Organization
Organization Name:SAN DIEGO FAMILY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:619-563-0507
Mailing Address - Street 1:4305 UNIVERISTY AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1690
Mailing Address - Country:US
Mailing Address - Phone:619-563-0507
Mailing Address - Fax:619-563-0015
Practice Address - Street 1:4305 UNIVERISTY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1690
Practice Address - Country:US
Practice Address - Phone:619-563-0507
Practice Address - Fax:619-563-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP11672FOtherEXPANDED ACESS TO PRIMARY
CAFHC71000GOtherMEDI CAL FQHC
CAFHC71000GOtherCHDP
CA80406OtherHEALTHY FAMILIES
CAFHC71000GOtherCHDP
CAW815Medicare ID - Type Unspecified