NPIMap

Organization Active NPI

Centro de Salud de la Comunidad de San Ysidro, Inc.

Doing business as San Ysidro Health Youth Enhancement Services

  • Adolescent and Children Mental Health Clinic/Center
  • San Diego, CA
National Provider Identifier
1013119569
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
San Ysidro Health Youth Enhancement Services
Practice address
1666 Precision Park LN
San Diego, CA 92173-1346
Phone
(619) 428-1330
Fax
(619) 482-7952
NPI assigned
Jun 5, 2007
Last updated
Jun 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian Wallace
Title
VP/Cfo
Phone
(619) 662-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

1666 Precision Park LN
San Diego, CA 92173-1346

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 428-1330

Other identifiers 1

IdentifierTypeStateIssuer
FHC18880FMedicaidCA

Other names 1

  • San Ysidro Health Youth Enhancement Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
San Ysidro Health Cente52 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1013119569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921731345",
            "telephone_number": "619-428-1330",
            "fax_number": "619-482-7952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1666 PRECISION PARK LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921731346",
            "telephone_number": "619-428-1330",
            "fax_number": "619-482-7952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "619-662-4100"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC18880F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Ysidro Health Youth Enhancement Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Ysidro Health Youth Enhancement Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.