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 Otay
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MATTSON (PRESIDENT/CEO)
(619) 662-4100
Entity
Organization
Contact information
Practice address
1637 3RD AVE SUITE B, C, F, H & I, CHULA VISTA, CA 91911-5823
(619) 662-4100
(619) 205-1376
Mailing address
1601 PRECISION PARK LN, SAN DIEGO, CA 92173-1345
(619) 662-4100
(619) 428-2625
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
090000136
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
551966
NGS MEDICARE PART A
CA
05
—
FHC11992H
—
CA
01
—
W5740C
NORIDIAN MEDICARE PART B
CA
Enumeration date
05/19/2006
Last updated
09/12/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up