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NPI Code Detail

MEDICARE: CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.

MEDICARE: CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1851757215
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Provider Business Mailing Address
First Line : 1601 PRECISION PARK LN
Second Line :
City : SAN DIEGO
State : CA
Zip : 92173-1345
Country : US
Telephone Number : 619-662-4100
Fax Number :
Provider Business Practice Location Address
First Line : 330-340 E. 8TH ST
Second Line :
City : NATIONAL CITY
State : CA
Zip : 91950-2312
Country : US
Telephone Number : 619-662-4100
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : KEVIN MATTSON
Credential :
Telephone Number : 619-622-4100
Provider Enumeration Date : 01/14/2016
Last Update Date : 11/06/2019

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