| Teen Health Center | |
|
1643 Logan Ave San Diego CA 92113-1004 | |
| (619) 515-2333 | |
| (619) 239-1015 |
| Full Name | Teen Health Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1643 Logan Ave, San Diego, California |
| Authorized Official Name and Position | Ricardo Roman (CFO) |
| Authorized Official Contact | 6199064603 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Teen Health Center 823 Gateway Center Way San Diego CA 92102-4541 Ph: (619) 515-2300 | Teen Health Center 1643 Logan Ave San Diego CA 92113-1004 Ph: (619) 515-2333 |
| NPI Number | 1982635470 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 02/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982635470 | NPI | - | NPPES |
| FHC70861F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 090000641 (California) | Primary |
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