Provider Demographics
NPI:1043926009
Name:OPERATION SAMAHAN INC
Entity Type:Organization
Organization Name:OPERATION SAMAHAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:PALIS
Authorized Official - Last Name:BELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-969-7770
Mailing Address - Street 1:1428 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-4624
Mailing Address - Country:US
Mailing Address - Phone:844-200-2426
Mailing Address - Fax:619-356-2726
Practice Address - Street 1:480 4TH AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4413
Practice Address - Country:US
Practice Address - Phone:844-200-2426
Practice Address - Fax:619-356-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699216622Medicaid
CA1275617169Medicaid
CA1801907449Medicaid
CA1205134517Medicaid
CA1871680397Medicaid