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1861316192 NPI number — CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.

NPI Number: 1861316192
Health Care Provider/Practitioner: CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.

Information about “1861316192” NPI (CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.) exists in 1861316192 in HTML format HTML  |  1861316192 in plain Text format TXT  |  1861316192 in PDF (Portable Document Format) PDF  |  1861316192 in an XML format XML  formats.

NPI Number : 1861316192 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861316192",
    "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": "404 EUCLID AVE STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN DIEGO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92114-2221",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-662-4100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/07/2026",
    "LastUpdateDate": "08/07/2026",
    "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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