Organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Active
Other names
San Ysidro Health El Cajon/San Diego PACE
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MATTSON (PRESIDENT AND CEO)
(619) 662-4100
Entity
Organization
Contact information
Practice address
875 EL CAJON BLVD, EL CAJON, CA 92020-5714
(619) 662-4100
(619) 205-6373
Mailing address
1601 PRECISION PARK LN, SAN DIEGO, CA 92173-1345
(619) 662-4100
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W5740
PART B PTAN
CA
Enumeration date
07/07/2015
Last updated
12/30/2020
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