Provider Demographics
NPI:1932187366
Name:FAMILY AND PREVENTIIVE MEDICAL CENTER
Entity Type:Organization
Organization Name:FAMILY AND PREVENTIIVE MEDICAL CENTER
Other - Org Name:FAMILY AND PREVENTIVE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:PROF
Authorized Official - First Name:BELEN
Authorized Official - Middle Name:MAYELA
Authorized Official - Last Name:SARWACINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:619-421-4257
Mailing Address - Street 1:13176 CALLE DE LOS NINOS SAN DIEGO, CA 92129
Mailing Address - Street 2:1415 RIDGE BACK ROAD #4
Mailing Address - City:CHULA VISTA,
Mailing Address - State:CA
Mailing Address - Zip Code:91910-0000
Mailing Address - Country:US
Mailing Address - Phone:619-421-4257
Mailing Address - Fax:
Practice Address - Street 1:13176 CALLE DE LOS NINOS SAN DIEGO, CA 92129 2919
Practice Address - Street 2:1415 RIDGEBACK ROAD #4
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6983
Practice Address - Country:US
Practice Address - Phone:619-421-4257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11952261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center