NPIMap

Organization Active NPI

Family Health Centers of San Diego, Inc

Doing business as South Bay Family Counseling Center

  • Federally Qualified Health Center (FQHC)
  • Imperial Beach, CA
National Provider Identifier
1336770445
Registry record updated Feb 20, 2024
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
South Bay Family Counseling Center
Practice address
742 10TH St
Imperial Beach, CA 91932-2216
Phone
(619) 906-5322
Fax
(619) 269-0484
NPI assigned
Jan 28, 2020
Last updated
Feb 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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) 515-2300

Specialties & licenses 1

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

Addresses

Primary practice location

742 10TH St
Imperial Beach, CA 91932-2216

Mailing address

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

Other names 1

  • South Bay Family Counseling Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210930001118 CA Part A Provider - Federally Qualified Health Center (FQHC) 3476446378 Practice locations: Imperial Beach, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336770445. Details of each certification follow.

Federally qualified health center certification: CCN A01028

Legal name
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Doing business as
SOUTH BAY FAMILY COUNSELING CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 27, 2021
Last certification
Sep 27, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 23, 1973 in CA
Enrollment address
742 10TH St
Imperial Beach, CA 91932-2216

National Provider Directory

National Provider Directory
Tax ID family
Diamond Neighborhoods Family Health Center Building a119 organizations share this tax ID, including this one

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

Locations

740 10th St
Imperial Beach, CA 91932
Phone (619) 906-5323

742 10th St
Imperial Beach, CA 91932
Phone (619) 515-2562

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 OfficerChief Financial Officer 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 and 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": "1580169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1336770445",
    "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": "742 10TH ST",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919322216",
            "telephone_number": "619-906-5322",
            "fax_number": "619-269-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SAN DIEGO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-28",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "619-515-2300"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Bay Family Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Bay Family Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Imperial Beach, CA

Sources for this page

Verify at the official NPI Registry.