Organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Active
Other names
San Ysidro Health San Ysidro Health Center
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 92173-2007
(619) 662-4100
(619) 205-6373
Mailing address
1601 PRECISION PARK LN, SAN DIEGO, CA 92173-1345
(619) 662-4100
(619) 428-7952
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
090000140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FHC18880F
MEDICAL
CA
01
—
W5740
MEDICARE PTAN PART B
—
Enumeration date
04/11/2006
Last updated
05/08/2019
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