Organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Active
Other names
GENERAL PHYSICIAN GROUP MULTI SPECIALTY
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MATTSON (PRESIDENT/CEO)
(619) 662-4100
Entity
Organization
Contact information
Practice address
4004 BEYER BLVD, SAN YSIDRO, CA 92173-2007
(619) 662-4100
(619) 428-7952
Mailing address
1601 PRECISION PARK LN, SAN DIEGO, CA 92173-1345
(619) 662-4100
(619) 428-7952
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
090000140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0041510
—
CA
Enumeration date
04/24/2007
Last updated
11/06/2019
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