Healthcare Provider Details

I. General information

NPI: 1346187440
Provider Name (Legal Business Name): CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 EL CAJON BLVD STE 101
EL CAJON CA
92020-5714
US

IV. Provider business mailing address

1601 PRECISION PARK LN
SAN DIEGO CA
92173-1345
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone: 619-662-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BRIAN WALLACE
Title or Position: VP/CFO
Credential:
Phone: 619-662-4100