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
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