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 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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