| St. Vincent De Paul Village Family Health Center | |
|
1501 Imperial Ave San Diego CA 92101-7638 | |
| (619) 233-8500 | |
| (619) 645-6470 |
| Full Name | St. Vincent De Paul Village Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1501 Imperial Ave, San Diego, California |
| Authorized Official Name and Position | Melinda Mallie (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6194462194 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Vincent De Paul Village Family Health Center 3350 E St San Diego CA 92102-3332 Ph: (619) 233-8500 | St. Vincent De Paul Village Family Health Center 1501 Imperial Ave San Diego CA 92101-7638 Ph: (619) 233-8500 |
| NPI Number | 1659415131 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 02/22/2023 |
| Medicare PECOS PAC ID | 9436295664 |
|---|---|
| Medicare Enrollment ID | O20091001000463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659415131 | NPI | - | NPPES |
| CMM70389F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | 09000297 (California) | Secondary |
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