CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. (NPI# 1164641965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164641965 |
| Entity Type | Organization |
| Organization Name | CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. |
| Other Organization Name | GENERAL PHYSICIAN GROUP MULTI SPECIALTY |
| Practice Address |
4004 Beyer Blvd San Ysidro CA 92173-2007 |
| Mailing Address |
1601 Precision Park Ln San Diego CA 92173-1345 |
| Practice Telephone | 6196624100 |
| Practice Fax Number | 6194287952 |
| Mailing Telephone | 6196624100 |
| Mailing Fax Number | 6194287952 |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-11-06 |
| Authorized Official Name | KEVIN MATTSON (PRESIDENT/CEO) |
| Authorized Official Telephone | 6196624100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
090000140 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0041510 | 05 |
| Other Name | Type Code |
|---|---|
| GENERAL PHYSICIAN GROUP MULTI SPECIALTY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851757215 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 330-340 E. 8th St, National City, CA 91950-2312 | 2016-01-14 |
| 1568845741 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 436 S Magnolia Ave Ste 101, El Cajon, CA 92020-5219 | 2015-07-07 |
| 1356750657 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 1058 3rd Ave, Chula Vista, CA 91911-2009 | 2014-08-12 |
| 1265843122 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 3364 Beyer Blvd, Suite #102 & #103, San Ysidro, CA 92173-1322 | 2014-05-14 |
| 1538262092 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 950 S Euclid Ave, San Diego, CA 92114-6201 | 2006-09-07 |
| 1922051812 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 1637 3rd Ave Ste B, Chula Vista, CA 91911-5823 | 2006-05-19 |
| 1003869363 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 1136 D Avenue, National City, CA 91950 | 2006-05-18 |
| 1801438239 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 255 N Ash St Ste 101, Escondido, CA 92027-3069 | 2019-10-17 |
| 1205477841 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 4690 El Cajon Blvd, San Diego, CA 92115-4403 | 2019-10-04 |
| 1376184911 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 120 Town Center Pkwy, Santee, CA 92071-5801 | 2019-10-04 |
| Street Address |
4004 BEYER BLVD |
| City | SAN YSIDRO |
| State | CA |
| Zip Code | 92173-2007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407852098 | Suzanne K Becker | Family Medicine | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2005-06-28 |
| 1508476474 | Manuela Mercedes Soto-mendez | Counselor | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2020-08-05 |
| 1912530312 | Yessica Lupita Hernandez | Registered Nurse | 4004 Beyer Blvd, San Ysidro, CA 92173-2099 | 2020-02-13 |
| 1477115327 | Karen Sales | Health Educator | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2019-07-01 |
| 1306408232 | Alma N Sandoval | Health Educator | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2019-07-01 |
| 1972165819 | Ariel Natalie Servin | Health Educator | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2019-07-01 |
| 1346700325 | Stephanie Smith | Psychologist | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2019-03-25 |
| 1164989919 | Valerie Ann Reyes Gaurano | Pharmacist | 4004 Beyer Blvd, San Ysidro, CA 92173-2099 | 2019-02-28 |
| 1184181224 | Warren Edwin Quigley | Pharmacist | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2019-02-25 |
| 1255845608 | Erika Andrea Reyes | Dental Hygienist | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2017-11-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740707595 | Edith Gisel Herrera | Specialist/Technologist | 2370 Smythe Avenue #8, San Ysidro, CA 92173 | 2017-08-23 |
| 1508286709 | Negin Rajaipour | Family Medicine | 1601 Precision Park Ln, San Ysidro, CA 92173 | 2014-04-26 |
| 1962588376 | Jose Maria Alanis Amezcua | Obstetrics & Gynecology | 185 West San Ysidro Blvd, San Ysidro, CA 92173 | 2006-10-27 |
| 1346251535 | Yadira L Gamez | Dentist | 2004 Dairy Mart Rd, Ste 120, San Ysidro, CA 92173 | 2006-08-11 |
| 1558852947 | Centro De Salud De La Comunidad De San Ysidro Inc | Clinic/Center | 4050 Beyer Blvd, San Ysidro, CA 92173 | 2018-05-22 |
| 1023215084 | Nanci Haruko Quinones Clifford | Physical Therapist | 4650 Palm Ave., San Diego, CA 92173-0000 | 2007-07-02 |
| 1891137386 | Altay Nikkisha Jones Johnson | Licensed Vocational Nurse | 3055 Iris Ave Unit D, San Ysidro, CA 92173-1146 | 2013-07-24 |
| 1689221558 | Hector Puga Hernandez | Driver | 1811 Howard Ave, San Ysidro, CA 92173-1238 | 2019-08-24 |
| 1689180846 | Amy Denise Reyes | Behavior Technician | 1829 Howard Ave, San Ysidro, CA 92173-1238 | 2017-12-22 |
| 1265843122 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 3364 Beyer Blvd, Suite #102 & #103, San Ysidro, CA 92173-1322 | 2014-05-14 |
| Find all providers in zip 92173 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265843122 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 3364 Beyer Blvd, Suite #102 & #103, San Ysidro, CA 92173-1322 | 2014-05-14 |
| 1558852947 | Centro De Salud De La Comunidad De San Ysidro Inc | Clinic/Center | 4050 Beyer Blvd, San Ysidro, CA 92173 | 2018-05-22 |
| 1538558978 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 3364 Beyer Blvd, Suite 102, San Ysidro, CA 92173-1322 | 2015-01-22 |
| 1952364747 | Centro De Salud De La Comunidad De San Ysidro, Inc. | Clinic/Center | 4004 Beyer Blvd, San Ysidro, CA 92173-2007 | 2006-04-11 |
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| Find all providers with the same taxonomy | ||||
| City | SAN YSIDRO |
| Zip Code | 92173 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.