CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO,INC (NPI# 1598308926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598308926 |
| Entity Type | Organization |
| Organization Name | CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO,INC |
| Other Organization Name | SAN YSIDRO HEALTH 25TH STREET FAMILY MEDICINE |
| Practice Address |
316 25th St San Diego CA 92102-3016 |
| Mailing Address |
1601 Precision Park Ln San Diego CA 92173-1345 |
| Practice Telephone | 6196624100 |
| Mailing Telephone | 6196624100 |
| Enumeration Date | 2019-10-17 |
| 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) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| San Ysidro Health 25th Street Family Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386972248 | Centro De Salud De La Comunidad De San Ysidro,inc | Custodial Care Facility | 3364 Beyer Blvd, San Ysidro, CA 92173-1322 | 2009-12-03 |
| Street Address |
316 25TH ST |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92102-3016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861603151 | Mountain Health & Community Services, Inc. | Clinic/Center | 316 25th St, San Diego, CA 92102-3016 | 2007-05-25 |
| 1174929194 | Carlos Rodriguez | Physician Assistant | 316 25th St, San Diego, CA 92102-3016 | 2014-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437766698 | Daniela Tablas | Behavioral Analyst | 303 47th St Spc D-22, San Diego, CA 92102 | 2020-09-30 |
| 1649745712 | Juliet Lao Kurek | Pharmacist | 2121 Imperial Avenue, San Diego, CA 92102 | 2018-10-04 |
| 1851887020 | Monique Joseph | Counselor | 2410 E. Street, San Diego, CA 92102 | 2018-07-10 |
| 1184166316 | Elise Blanton-hubbard | Counselor | 1850 Dale St, San Diego, CA 92102 | 2016-11-04 |
| 1699221416 | Kari Judith Medina | Student in an Organized Health Care Education/Training Program | 1199 34th Street Apt 11, San Diego, CA 92102 | 2016-08-31 |
| 1942674536 | Caitlin Hillary Dablow | Speech-Language Pathologist | 1201 34th Street, San Diego, CA 92102 | 2015-11-19 |
| 1134508179 | Jonathan Waters | Military Health Care Provider | 1233 22nd Street, Unit 8, San Diego, CA 92102 | 2015-05-22 |
| 1871989913 | Abraham Greenberg | Pediatrics | 15 Balfour Street, Jerusalem, ISRAEL 92102 | 2015-04-15 |
| 1023421021 | Elmira Aghdam | Chiropractor | 5030 Bonita Rd Ste#b, Bonita, CA 92102 | 2014-06-06 |
| 1487092540 | Sherry Scott | Marriage & Family Therapist | 995 Gateway Center Drive #300, San Diego, CA 92102 | 2013-06-11 |
| Find all providers in zip 92102 | ||||
| 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 |
|---|---|---|---|---|
| 1043856362 | Family Health Centers of San Diego, Inc | Clinic/Center | 1401 Imperial Ave, San Diego, CA 92101-7527 | 2019-11-21 |
| 1245893072 | Mountain Health & Community Services, Inc. | Clinic/Center | 4440 Euclid Ave Ste C, San Diego, CA 92115-4522 | 2019-04-17 |
| 1093298879 | Family Health Centers of San Diego, Inc | Clinic/Center | 3420 College Ave, San Diego, CA 92115-7134 | 2018-09-08 |
| 1386158483 | Operation Samahan, Inc. | Clinic/Center | 10737 Camino Ruiz Ste 138, San Diego, CA 92126-2361 | 2017-11-28 |
| 1386168193 | San Diego Family Care | Clinic/Center | 6979 Linda Vista Rd, San Diego, CA 92111-6342 | 2017-08-02 |
| 1841714656 | San Diego Family Care | Clinic/Center | 6985 Linda Vista Rd, San Diego, CA 92111-6342 | 2017-08-02 |
| 1699216622 | Operation Samahan Inc | Clinic/Center | 9995 Carmel Mountain Rd, Suite B10 & B11, San Diego, CA 92129-2889 | 2017-03-09 |
| 1235521782 | Family Health Centers of San Diego Inc | Clinic/Center | 2325 Commercial St, Ste 1400, San Diego, CA 92113-1189 | 2015-02-20 |
| 1265831960 | La Maestra Family Clinic, Inc. | Clinic/Center | 4171 Fairmount Ave, San Diego, CA 92105-1609 | 2014-08-19 |
| 1952729303 | Family Health Centers of San Diego Inc | Clinic/Center | 1550 Broadway, Suite 2, San Diego, CA 92101 | 2014-04-02 |
| Find all providers in SAN DIEGO | ||||
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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.