NPIMap

Organization Active NPI

Imperial Beach Community Clinic

Doing business as Nestor Community Health Center

  • Community Health Clinic/Center
  • San Diego, CA
National Provider Identifier
1215246996
Registry record updated Sep 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
IMPERIAL BEACH COMMUNITY CLINIC
Doing business as
Nestor Community Health Center
Practice address
1016 Outer Rd
San Diego, CA 92154-1351
Phone
(619) 429-3733
Fax
(619) 429-6457
NPI assigned
Sep 29, 2010
Last updated
Sep 29, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
IMPERIAL BEACH COMMUNITY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2010

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

Authorized official

Name
Constance Kirk
Title
Executive Director
Phone
(619) 429-5387

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

1016 Outer Rd
San Diego, CA 92154-1351

Mailing address

PO Box 459
Imperial Beach, CA 91933-0459
Phone (619) 429-3733

Other names 1

  • Nestor Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110602000200 CA Part A Provider - Federally Qualified Health Center (FQHC) 6709867880 Practice locations: San Diego, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215246996. Details of each certification follow.

Federally qualified health center certification: CCN 551089

Legal name
IMPERIAL BEACH COMMUNITY CLINIC
Doing business as
NESTOR COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 2, 2011
Last certification
Jun 2, 2011
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Enrollment address
1016 Outer Rd
San Diego, CA 92154-1351

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2023199Nestor Community Health Center1016 Outer Road, San Diego, CA 92154Provider-performed microscopyApr 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Imperial Beach Comm Clinic2 organizations share this tax ID, including this one
Part of
Imperial Beach Comm Clinic

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1016 Outer Rd
San Diego, CA 92154
Phone (619) 429-3733

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10012052
  • FHIR API: https://fhir4.healow.com/fhir/r4/EBEEDD

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Monica Jaikaran Individual Corporate DirectorBoard Member May 1, 2016
Bertha Hernandez Individual Corporate DirectorBoard Member May 1, 2012
Rashmi B Savgur Individual Corporate DirectorBoard Member Jan 15, 2025
Mary Coates Individual Corporate DirectorBoard Member Jan 1, 2010
Venissa L Valenzuela Individual Corporate DirectorBoard Member Mar 5, 2020
Henry Santellanes Individual Corporate DirectorBoard Member Nov 1, 2022
Reyna a Puente Individual Corporate DirectorBoard Member Jan 15, 2026
Breanna J Reyes Individual Corporate DirectorBoard Member Jan 15, 2026
Veronica Nicole Palomino Individual Corporate OfficerCmo Oct 1, 2025
Victoria Gonzalez-Rivera Individual Corporate DirectorBoard Member May 1, 2007
Martha S Ceballos Individual W-2 Managing EmployeeOffice Manager Feb 1, 2011 15%
Zachary Lambert Individual Corporate OfficerCfo Dec 5, 2025
Albert Pacheco Individual Corporate OfficerChief Executive Officer Jul 1, 2025 100%
Angel Maria Anderson Individual Corporate DirectorBoard Member Jan 15, 2026
Daniela E Sanchez Individual Corporate DirectorBoard Member Jan 15, 2026

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1285718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285718400000",
    "number": "1215246996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919330459",
            "telephone_number": "619-429-3733",
            "fax_number": "619-429-6457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 OUTER RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921541351",
            "telephone_number": "619-429-3733",
            "fax_number": "619-429-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL BEACH COMMUNITY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMPERIAL BEACH COMMUNITY CLINIC",
        "enumeration_date": "2010-09-29",
        "last_updated": "2010-09-29",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "619-429-5387"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nestor Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.