| Chase Avenue Family Health Center | |
|
1111 W Chase Ave El Cajon CA 92020-5710 | |
| (619) 515-2499 | |
| (619) 593-9164 |
| Full Name | Chase Avenue Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1111 W Chase Ave, El Cajon, California |
| Authorized Official Name and Position | Ricardo Roman (CFO) |
| Authorized Official Contact | 6195152300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chase Avenue Family Health Center 823 Gateway Center Way San Diego CA 92102-4541 Ph: (619) 515-2300 | Chase Avenue Family Health Center 1111 W Chase Ave El Cajon CA 92020-5710 Ph: (619) 515-2499 |
| NPI Number | 1104861681 |
|---|---|
| Provider Enumeration Date | 06/18/2006 |
| Last Update Date | 02/20/2024 |
| Medicare PECOS PAC ID | 3476446378 |
|---|---|
| Medicare Enrollment ID | O20100825000159 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104861681 | NPI | - | NPPES |
| W5352E | Other | CA | MEDICARE - NHIC |
| FHC70856F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 090000631 (California) | Primary |
| Provider Name | Carol Hastanan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861648461 PECOS PAC ID: 9931386687 Enrollment ID: I20110606000305 |
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