Dap Health, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Escondido, CA
NPI 1023349883 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1023349883
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- DAP HEALTH, INC.
- Practice address
- 1121 E Washington Ave
Escondido, CA 92025-2214 - Phone
- (760) 871-0606
- Fax
- (760) 871-3534
- NPI assigned
- Jan 19, 2010
- Organization subpart
- No
Authorized official
- Name
- Judy Stith
- Title
- Chief Administrative Officer
- Phone
- (760) 323-2118
Other NPIs on the same Medicare enrollment 14
Other NPIs with the same Medicare PAC ID 14
Practitioners 67
-
Flordeliza Medina Burns, P.A.-C.
-
Zenziwe Matshe, MD
-
Marlyne Abon, NURSE PRACTITIONER
-
Kenneth Tembei Acha, M.D.
-
Karrar H. Ali, D.O.
-
Joseph Aquilina, MD
-
Muhammad Arif, MD
-
Clayton O Barbour II, M.D.
-
Emma Bermudez, NP
-
Felipe Mendez Cendejas, PA-C
-
Joseph George Cerjan, M.D.
-
Vache Chakmakian, M.D.
-
Lorraine Y Chun, M.D.
-
Lyle Cook, PA
-
William E Daniel, APRN, MSN, FNP-BC
-
Monica Diaz, FNP-C
-
Robert Fontanilla, PA-C
-
Dauod Ghafari, MD
-
Sergio Vincente Godinez, PA-C
-
Mario Alberto Gonzalez, MSN/FNP
-
Silas Gyimah, M.D
-
Reynaldo Hacinas, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0998063 | Dap Health - Centro Medico Escondido | Certificate of waiver | Apr 2, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 751029
- Legal name
- DAP HEALTH INC
- Doing business as
- DAP - CENTRO MEDICO ESCONDIDO
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 11, 2013
- Last certification
- Dec 11, 2013
- Ownership / control type
- For profit – corporation
- Most recent change of ownership
- Aug 1, 2023 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 22, 1984 in CA
- Enrollment address
- 1121 E Washington Ave
Escondido, CA 92025-2214
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| David Brinkman |
Corporate Officer |
Aug 1, 2023 | |
| Patrick Jordan |
Corporate Director |
Aug 1, 2023 | |
| Frederick Drewette |
Corporate Director |
Aug 1, 2023 | |
| Gladis Adriana Perez |
W-2 Managing Employee |
Aug 1, 2023 | |
| Veronica Willimas |
Corporate Director |
Feb 27, 2024 | |
| Judy Stith |
Corporate Officer |
Aug 1, 2023 | |
| Athalie Lapamuk |
Corporate Director |
Aug 1, 2023 | |
| Scot Karp |
Corporate Director |
Jun 1, 2024 | |
| Mark Charles Adams |
Corporate Director |
Jun 1, 2024 | |
| Kevin Bass |
Corporate Director |
Aug 1, 2023 | |
| Carolyn Caldwell |
Corporate Director |
Aug 1, 2023 | |
| Bruce Finch |
Corporate Director |
Aug 1, 2023 | |
| Karyl Ketchum |
Corporate Director |
Aug 1, 2023 | |
| Frank Figueroa |
Corporate Director |
Aug 1, 2023 | |
| Eve Fromberg |
Corporate Director |
Aug 1, 2023 | |
| Mark Hamilton |
Corporate Director |
Aug 1, 2023 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Aug 1, 2023 | Change of Ownership |
Centro Medico, Escondido |
| Aug 1, 2023 | Change of Ownership |
Dap - Centro Medico Escondido |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100608000193 | CA | Part B Supplier - Clinic/Group Practice | 6002989522 |
Receives reassigned benefits from 103 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Thermal, CA; San Jacinto, CA; Cathedral City, CA; Palm Springs, CA; Escondido, CA; El Cajon, CA; Desert Hot Springs, CA; Coachella, CA… |
| O20240606004190 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 6002989522 | Practice locations: Escondido, CA |
National Provider Directory
Locations
1151 E Washington Ave
Ste C
Escondido, CA 92025
Phone (760) 871-0606
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1121 E Washington Ave
Escondido, CA 92025-2214
Mailing address
1695 N. Sunrise Way
Palm Springs, CA 92262
Phone (760) 323-2118
Other names
- DAP Health-Centro Medico Escondido-1121 Washington
Other providers in Escondido, CA
- Pamela Ong-Veloso Danque
- Roberto Dantes
- Jennifer M. Danz
- Loan Dao
- Marc K Dao
- Dap Health, Inc.
- Dash Solutions, LLC
- Anahita Dashtaei
- Tariq M Dastagir
- Sarah Golshan Davey
All providers in Escondido, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.