NPIMap

Organization Active NPI

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

Doing business as San Diego PACE Vista

  • PACE Provider Organization
  • Vista, CA
National Provider Identifier
1124793732
Registry record updated Jan 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
San Diego PACE Vista
Practice address
1840 West Dr
Vista, CA 92083-6115
Phone
(619) 662-4100
NPI assigned
Aug 16, 2021
Last updated
Jan 27, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2026

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

Authorized official

Name
Kevin Mattson
Title
President/Ceo
Phone
(619) 662-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Primary

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 1

  • San Diego PACE Vista Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124793732. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Feb 5, 1971 in CA
Enrollment address
1840 West Dr
Vista, CA 92083-6115

Other NPIs on the same Medicare enrollment 40

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 40

National Provider Directory

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

Organizations with this tax ID in the same state 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tomas Urtasun Individual Corporate OfficerBoard Member Apr 1, 2010
Guillermo Gomez Individual Corporate OfficerBoard Member Oct 20, 2012
Catalina Valencia Individual Corporate OfficerBoard Member Oct 28, 2017
William Wallace Individual Corporate OfficerVP/Cfo Jan 20, 2016
Victor Nieto Individual Corporate OfficerBoard Member Jan 27, 1999
Reynaldo Perez Individual Corporate OfficerBoard Member Apr 1, 1995
Michael Dew Individual Corporate DirectorDirector of Managed Care Dec 1, 2021
W-2 Managing EmployeeDirector of Managed Care Dec 1, 2021
Terry Whitaker Individual Corporate OfficerSr.VP of Facility Developement Dec 15, 1998
Sergio Cuevas Individual Corporate DirectorDental Director May 7, 2001
Fred Dorsey Individual Corporate OfficerBoard Member Oct 20, 2016
Kusay I Arabo Individual Corporate OfficerBoard Member Aug 24, 2017
Gloria Ramirez Individual Corporate OfficerBoard Member Aug 4, 1994
Macario Gutierrez Individual Corporate OfficerBoard Member May 20, 1975
Kevin Mattson Individual Corporate OfficerPresident/Ceo Jul 1, 2002

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
San Ysidro Health CHC-Ocean ViewSan Diego, CA, CCN 551920 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2008
San Ysidro Health EuclidSan Diego, CA, CCN 551922 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2009
San Ysidro Health OtayChula Vista, CA, CCN 551966 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 5, 1971
San Ysidro Health San Diego Pace/Senior Health ServicesSan Ysidro, CA, CCN 751102 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2014
San Ysidro Health El Cajon/San Diego PaceEl Cajon, CA, CCN 751822 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2015
San Ysidro Health South BayNational City, CA, CCN 751950 Federally qualified health center 5% Or Greater Direct Ownership Interest (5%) Jun 1, 2016

Practitioners & affiliated clinicians

Practitioners 12

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": "1629072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769472000000",
    "number": "1124793732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 DAGGET ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112333",
            "telephone_number": "619-662-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 WEST DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836115",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.",
        "enumeration_date": "2021-08-16",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A",
        "authorized_official_last_name": "MATTSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "619-662-4100"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Diego PACE Vista",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.