Organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Active
Other names
San Ysidro Health Youth Enhancement Services
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN WALLACE (VP/CFO)
(619) 662-4100
Entity
Organization
Contact information
Practice address
1666 PRECISION PARK LN, SAN DIEGO, CA 92173-1346
(619) 428-1330
(619) 482-7952
Mailing address
1601 PRECISION PARK LN, SAN DIEGO, CA 92173-1345
(619) 428-1330
(619) 482-7952
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC18880F
—
CA
Enumeration date
06/05/2007
Last updated
06/03/2022
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