Organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Active
Other names
San Ysidro Health Pharmacy-CHC Ocean View
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MATTSON (PRESIDENT/CEO)
(619) 662-4100
Entity
Organization
Contact information
Practice address
3177 OCEAN VIEW BLVD, SAN DIEGO, CA 92113-1432
(619) 662-4100
(619) 205-6373
Mailing address
1601 PRECISION PARK LN, SAN DIEGO, CA 92173-1345
(619) 205-6349
(619) 428-7952
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY49259
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0565183
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/27/2007
Last updated
11/06/2019
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