NPI Code Detail JSON Logo

1124939665 NPI number — CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.

NPI Number: 1124939665
Health Care Provider/Practitioner: CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.

Information about “1124939665” NPI (CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.) exists in 1124939665 in HTML format HTML  |  1124939665 in plain Text format TXT  |  1124939665 in PDF (Portable Document Format) PDF  |  1124939665 in an XML format XML  formats.

NPI Number : 1124939665 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124939665",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1601 PRECISION PARK LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92173-1345",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "480 4TH AVE STE 102&401",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHULA VISTA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91910-4410",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-662-4100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/14/2026",
    "LastUpdateDate": "09/14/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WALLACE",
    "AuthorizedOfficialFirstName": "WILLIAM",
    "AuthorizedOfficialMiddleName": "BRIAN",
    "AuthorizedOfficialTitle": "VP/CFO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "619-662-4100",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QF0400X",
        "TaxonomyName": "Federally Qualified Health Center (FQHC)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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