NPIMap

Organization Active NPI

Family Health Centers of San Diego, Inc

Doing business as Ibarra Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1114700119
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH CENTERS OF SAN DIEGO, INC
Doing business as
Ibarra Family Health Center
Practice address
4874 Polk Ave
San Diego, CA 92105-2026
Phone
(619) 515-2300
Fax
(619) 237-1856
NPI assigned
Aug 15, 2023
Last updated
Jun 1, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY HEALTH CENTERS OF SAN DIEGO, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ricardo Roman
Title
Chief Financial Officer
Phone
(619) 906-4603

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

4874 Polk Ave
San Diego, CA 92105-2026

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Other names 1

  • IBARRA FAMILY HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150219001372 CA Part A Provider - Federally Qualified Health Center (FQHC) 3476446378 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Diego, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114700119. Details of each certification follow.

Federally qualified health center certification: CCN 751141

Legal name
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Doing business as
IBARRA FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 13, 2015
Last certification
Feb 13, 2015
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
May 23, 1973 in CA
Enrollment address
4874 Polk Ave
San Diego, CA 92105-2026

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Logan Heights Family HL118 organizations share this tax ID, including this one
Part of
Logan Heights Family HL

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ricardo Roman Individual Corporate OfficerCfo Sep 20, 2010
Bertha Garcia Individual Corporate DirectorBoard Member Nov 12, 1992
Mary Teresa Sessom Individual Corporate DirectorBoard Member Sep 18, 2013
Daniel Guillen Individual Corporate DirectorBoard Member Jul 24, 2013
Margarita I Carmona Individual Corporate DirectorBoard Member Aug 21, 1978
Venus F Thomas Individual Corporate DirectorBoard Member Mar 15, 2000
Sean Mathews Individual Corporate DirectorBoard Member Jul 24, 2013
Barbara J Carr Individual Corporate DirectorBoard Member Jun 18, 1997
Jose R de la Garza Individual Corporate DirectorBoard Member Jul 29, 1985
Frank Espinoza Individual Corporate DirectorBoard Member Jul 24, 2013
Christopher Gordon Individual W-2 Managing EmployeeMedical Director Sep 17, 2016
Wayne R Anderson Individual Corporate DirectorBoard Member Jun 20, 2007
Fran Butler-Cohen Individual Corporate OfficerPresident/Ceo Jan 21, 1986

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780272000000",
    "number": "1114700119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300",
            "fax_number": "619-237-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4874 POLK AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921052026",
            "telephone_number": "619-515-2300",
            "fax_number": "619-237-1856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SAN DIEGO, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY HEALTH CENTERS OF SAN DIEGO, INC",
        "enumeration_date": "2023-08-15",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "619-906-4603"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IBARRA FAMILY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.