Provider Demographics
NPI: | 1760098503 |
---|---|
Name: | CHICAGO CLINICA MEDICA FAMILIAR OPERATED BY NEIGHBORHOOD HEALTHCARE |
Entity Type: | Organization |
Organization Name: | CHICAGO CLINICA MEDICA FAMILIAR OPERATED BY NEIGHBORHOOD HEALTHCARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RAKESH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PATEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 760-520-8300 |
Mailing Address - Street 1: | 425 N DATE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ESCONDIDO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92025-3413 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 760-520-8300 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4022 CHICAGO AVE STE A |
Practice Address - Street 2: | |
Practice Address - City: | RIVERSIDE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92507-5340 |
Practice Address - Country: | US |
Practice Address - Phone: | 760-520-8300 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-09-17 |
Last Update Date: | 2020-09-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |