Centro de Salud de la Comunidad de San Ysidro, Inc.
Organization Active NPI PACE Provider Organization · Vista, CA
NPI 1124793732 · NPPES record last updated Jan 27, 2026
Key facts
- NPI
- 1124793732
- Entity type
- Organization (NPI type 2)
- Primary specialty
- PACE Provider Organization 251T00000X
- Legal business name
- CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
- Practice address
- 1840 West Dr
Vista, CA 92083-6115 - Phone
- (619) 662-4100
- NPI assigned
- Aug 16, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Authorized official
- Name
- Kevin Mattson
- Title
- President/Ceo
- Phone
- (619) 662-4100
Owners & managing parties with NPI records 2
-
Kusay Isam Arabo, O.D.
-
Sergio Cuevas, DDS
Other NPIs on the same Medicare enrollment 40
Corporate family (same tax ID) 16
Practitioners 12
-
Rene' Marie Arlinghaus, LCSW
-
Karla Jannet Garcia, M.D., M.P.H.
-
Daniel J Hiles, MD
-
Rami Michael, MD
-
Pamela Mitchell, MPT
-
Aurore Marie Oughourlian, M.D.
-
Naghmeh Rowhani, M.D.
-
Dylan Scott Tayag, LCSW
-
Queen Lucky Thach, O.D.
-
Randall Patricio Torres, PSYD
-
Emily A Troyer, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN A01098
- Legal name
- CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
- Doing business as
- SAN YSIDRO HEALTH SAN DIEGO PACE VISTA
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 15, 2022
- Last certification
- Aug 15, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 5, 1971 in CA
- Enrollment address
- 1840 West Dr
Vista, CA 92083-6115
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Tomas Urtasun |
Corporate Officer |
Apr 1, 2010 | |
| Guillermo Gomez |
Corporate Officer |
Oct 20, 2012 | |
| Catalina Valencia |
Corporate Officer |
Oct 28, 2017 | |
| William Wallace |
Corporate Officer |
Jan 20, 2016 | |
| Victor Nieto |
Corporate Officer |
Jan 27, 1999 | |
| Reynaldo Perez |
Corporate Officer |
Apr 1, 1995 | |
| Michael Dew |
Corporate Director |
Dec 1, 2021 | |
| W-2 Managing Employee |
Dec 1, 2021 | ||
| Terry Whitaker |
Corporate Officer |
Dec 15, 1998 | |
| Sergio Cuevas |
Corporate Director |
May 7, 2001 | |
| Fred Dorsey |
Corporate Officer |
Oct 20, 2016 | |
| Kusay I Arabo |
Corporate Officer |
Aug 24, 2017 | |
| Gloria Ramirez |
Corporate Officer |
Aug 4, 1994 | |
| Macario Gutierrez |
Corporate Officer |
May 20, 1975 | |
| Kevin Mattson |
Corporate Officer |
Jul 1, 2002 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| San Ysidro Health CHC-Ocean View |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Aug 25, 2008 |
| San Ysidro Health Euclid |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Aug 25, 2009 |
| San Ysidro Health Otay |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Feb 5, 1971 |
| San Ysidro Health San Diego Pace/Senior Health Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Sep 1, 2014 |
| San Ysidro Health El Cajon/San Diego Pace |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2015 |
| San Ysidro Health South Bay |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (5%) | Jun 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040130000711 | CA | Part B Supplier - Clinic/Group Practice | 6901709435 |
Receives reassigned benefits from 611 practitioners 41 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: National City, CA; San Diego, CA; San Ysidro, CA; Santee, CA; Vista, CA; Alpine, CA; Campo, CA; Chula Vista, CA… |
| O20220824001077 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 6901709435 | Practice locations: Vista, CA |
National Provider Directory
- Tax ID family
- Centro de Salud de la Comun
- Part of
- Centro de Salud de la Comun
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| PACE Provider Organization | 251T00000X | Yes |
Addresses
Primary practice location
1840 West Dr
Vista, CA 92083-6115
Mailing address
8080 Dagget St
San Diego, CA 92111-2333
Phone (619) 662-4100
Other names
- San Diego PACE Vista
Other providers in Vista, CA
- Emilio Javier Cavazos
- Irma Cazarez
- Daisy Cedillo
- Beatriz Celis
- Center for Hip Preservation and Children'S Orthopaedics Inc.
- Nadine Marie Cerqua
- Heidi Z Cevallos
- Consuelo Gil Chaffee
- Kevin David Chalk
- Kaliana Chamberlin
All providers in Vista, CA · PACE Provider Organization in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.