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255 N Ash St Ste 101 Escondido CA 92027-3069 | |
| (760) 745-5832 | |
| (760) 745-7847 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 255 N Ash St Ste 101, Escondido, California |
| Authorized Official Name and Position | Judith Shaplin (CEO) |
| Authorized Official Contact | 6194456200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
31115 Highway 94 Campo CA 91906-3133 Ph: (619) 478-5254 | 255 N Ash St Ste 101 Escondido CA 92027-3069 Ph: (760) 745-5832 |
| NPI Number | 1063613263 |
|---|---|
| Provider Enumeration Date | 05/29/2007 |
| Last Update Date | 10/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063613263 | NPI | - | NPPES |
| FHC71188F | Medicaid | CA | |
| BCP71188F | Other | CA | STATE PROGRAM |
| HAP71188F | Other | CA | STATE PROGRAM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550000560 (California) | Primary |
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