Organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Active
Organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Active
Other names
San Ysidro Health Pharmacy-San Ysidro
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MATTSON (PRESIDENT AND CEO)
(619) 662-4100
Entity
Organization
Contact information
Practice address
4004 BEYER BLVD, SAN YSIDRO, CA 92173
(619) 662-4100
(619) 205-6373
Mailing address
1601 PRECISION PARK LN, SAN DIEGO, CA 92173-1345
(619) 662-4100
(619) 428-2625
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DREPHA382000
FPACT
CA
Enumeration date
10/25/2006
Last updated
06/24/2021
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