Organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO INC
Active
Other names
San Ysidro Health CHC-Ocean View
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MATTSON (PRESIDENT/CEO)
(619) 662-4100
Entity
Organization
Contact information
Practice address
3177 OCEAN VIEW BLVD, SAN DIEGO, CA 92113-1432
(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
090000143
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC11998G
—
CA
01
—
W5740
MEDICARE PART B PTAN
CA
Enumeration date
01/29/2008
Last updated
11/06/2019
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