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General NPI Number Information
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NPI Number | 1184801433
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Entity Type | Organization
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Legal Business Name | CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO,INC.
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 340 4TH AVE STE 6&7
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City | CHULA VISTA
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State | CA
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Zip | 91910-3813
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Country | US
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Telephone | 619-662-4100
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Fax | 619-428-7952
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Provider Business Mailing Address
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Address Line | 1275 30TH ST
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City | SAN DIEGO
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State | CA
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Zip | 92154-3476
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Country | US
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Telephone | 619-662-4100
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Fax | 619-428-7952
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Authorized Official
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Title or Position | CFO
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Name | GILBERT FIMBRES
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Credential |
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Telephone | 619-205-6331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 550000782
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License Number State | CA
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