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128 N Broadway Escondido CA 92025-2714 | |
(760) 546-2858 | |
(619) 255-7964 |
Full Name | |
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Speciality | Clinic/Center |
Location | 128 N Broadway, Escondido, California |
Authorized Official Name and Position | Ricardo Roman (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 6195152300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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823 Gateway Center Way San Diego CA 92102-4541 Ph: (619) 515-2300 | 128 N Broadway Escondido CA 92025-2714 Ph: (760) 546-2858 |
NPI Number | 1417640491 |
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Provider Enumeration Date | 05/26/2023 |
Last Update Date | 02/20/2024 |
Medicare PECOS PAC ID | 3476446378 |
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Medicare Enrollment ID | O20231023000581 |
Identifier | Type | State | Issuer |
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1417640491 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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