SAN DIEGO FAMILY CARE (NPI# 1912033572) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912033572 |
| Entity Type | Organization |
| Organization Name | SAN DIEGO FAMILY CARE |
| Other Organization Name | MID CITY COMMUNITY CLINIC |
| Practice Address |
4290 Polk Avenue San Diego CA 92105-1524 |
| Mailing Address |
6973 Linda Vista Road San Diego CA 92111-6339 |
| Practice Telephone | 6195630507 |
| Practice Fax Number | 6195630015 |
| Mailing Telephone | 8582799676 |
| Mailing Fax Number | 8582790377 |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. ROBERTA LEE FEINBERG (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 8582799676 |
| Authorized Official Credential | MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | HAP | HAP11882G | 01 |
| Other Name | Type Code |
|---|---|
| Mid City Community Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386168193 | San Diego Family Care | Clinic/Center | 6979 Linda Vista Rd, San Diego, CA 92111-6342 | 2017-08-02 |
| 1841714656 | San Diego Family Care | Clinic/Center | 6985 Linda Vista Rd, San Diego, CA 92111-6342 | 2017-08-02 |
| 1306827332 | San Diego Family Care | Clinic/Center | 4290 Polk Ave, San Diego, CA 92105-1524 | 2005-11-08 |
| 1962483040 | San Diego Family Care | Clinic/Center | 4305 Univeristy Ave, Suite 150, San Diego, CA 92105-1690 | 2005-11-07 |
| 1457724858 | San Diego Family Care | Dentist | 7011 Linda Vista Rd, San Diego, CA 92111-6307 | 2015-11-06 |
| 1023135373 | San Diego Family Care | Clinic/Center | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2007-03-23 |
| 1730218348 | San Diego Family Care | Clinic/Center | 6973 Linda Vista Road, San Diego, CA 92111-6339 | 2007-03-02 |
| 1609905215 | San Diego Family Care | Clinic/Center | 6973 Linda Vista Road, San Diego, CA 92111-6339 | 2007-03-02 |
| 1184753790 | San Diego Family Care | Clinic/Center | 6973 Linda Vista Road, San Diego, CA 92111-6339 | 2007-03-02 |
| 1780665877 | San Diego Family Care | Clinic/Center | 6973 Linda Vista Rd, San Diego, CA 92111-6339 | 2005-11-07 |
| Street Address |
4290 POLK AVENUE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92105-1524 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710932876 | Sheryl Lynn Parker | Registered Nurse | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2006-05-24 |
| 1063856805 | Elaine Rose Ocampo | Registered Nurse | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2013-04-23 |
| 1770893620 | Paula Elaine Engel | Registered Nurse | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2010-10-13 |
| 1376851378 | Tammie L Goulart | Registered Nurse | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2010-09-24 |
| 1366768525 | Jillion T. Harris | Family Medicine | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2010-04-13 |
| 1659609600 | Thanh Lam Nguyen | Registered Nurse | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2009-12-03 |
| 1013245067 | Linnea Belle Daley | Registered Nurse | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2009-12-03 |
| 1780816082 | Amelia Shamsi Polheber | Nurse Practitioner | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2009-08-20 |
| 1922237809 | Shawna Akiko Hirata Johnson | Nurse Practitioner | 4290 Polk Avenue, San Diego, CA 92105 | 2009-07-13 |
| 1114177060 | Sharon Elizabeth Aswegan | Registered Nurse | 4290 Polk Avenue, San Diego, CA 92105-1524 | 2008-09-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851934798 | Point Loma Nazarene University | Nurse Practitioner | Point Loma Nazarene University Health Promotion Center, 4101 University Avenue, San Diego, CA 92105 | 2019-10-23 |
| 1104478809 | Kristin Lynn Nichols | Counselor | 4823 El Cajon Blvd Suite #115, San Diego, CA 92105 | 2019-07-12 |
| 1205343076 | Momentum Learning | Counselor | 3720 El Cajon Blvd., Sd, CA 92105 | 2018-01-03 |
| 1306352695 | Nathan Hien Le, Dds. Inc | Dentist | 4170 Fairmount Ave., San Diego, CA 92105 | 2017-12-21 |
| 1073038071 | Aika Mary Erlandson | Student in an Organized Health Care Education/Training Program | 5296 University Ave. Suite F-2, San Diego, CA 92105 | 2017-08-10 |
| 1457872178 | Ride-in Transport LLC | Non-emergency Medical Transport (VAN) | 4061 Fairmount Ave, San Diego, CA 92105 | 2017-07-03 |
| 1598205346 | Ahmed Mooge | Ambulance | 4061 Fairmout Ave, San Diego, CA 92105 | 2017-02-27 |
| 1083152748 | Rady Childrens Hospital-san Diego | Psychiatric Unit | 4305 University Avenue, Suite 150, San Diego, CA 92105 | 2017-02-02 |
| 1730634098 | Med Specialty Sai Inc. | Pharmacy | 4153 University Avenue, Suite B, San Diego, CA 92105 | 2016-08-16 |
| 1568857464 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 4074 Fairmount Avenue, Suite B, San Diego, CA 92105 | 2015-03-30 |
| Find all providers in zip 92105 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043856362 | Family Health Centers of San Diego, Inc | Clinic/Center | 1401 Imperial Ave, San Diego, CA 92101-7527 | 2019-11-21 |
| 1245893072 | Mountain Health & Community Services, Inc. | Clinic/Center | 4440 Euclid Ave Ste C, San Diego, CA 92115-4522 | 2019-04-17 |
| 1093298879 | Family Health Centers of San Diego, Inc | Clinic/Center | 3420 College Ave, San Diego, CA 92115-7134 | 2018-09-08 |
| 1386158483 | Operation Samahan, Inc. | Clinic/Center | 10737 Camino Ruiz Ste 138, San Diego, CA 92126-2361 | 2017-11-28 |
| 1386168193 | San Diego Family Care | Clinic/Center | 6979 Linda Vista Rd, San Diego, CA 92111-6342 | 2017-08-02 |
| 1841714656 | San Diego Family Care | Clinic/Center | 6985 Linda Vista Rd, San Diego, CA 92111-6342 | 2017-08-02 |
| 1699216622 | Operation Samahan Inc | Clinic/Center | 9995 Carmel Mountain Rd, Suite B10 & B11, San Diego, CA 92129-2889 | 2017-03-09 |
| 1235521782 | Family Health Centers of San Diego Inc | Clinic/Center | 2325 Commercial St, Ste 1400, San Diego, CA 92113-1189 | 2015-02-20 |
| 1265831960 | La Maestra Family Clinic, Inc. | Clinic/Center | 4171 Fairmount Ave, San Diego, CA 92105-1609 | 2014-08-19 |
| 1952729303 | Family Health Centers of San Diego Inc | Clinic/Center | 1550 Broadway, Suite 2, San Diego, CA 92101 | 2014-04-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.