San Diego Pediatrics & Family Medical Clinic

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A42572 Issued in CA

Legal business name

SAN DIEGO PEDIATRICS & FAMILY MEDICAL CLINIC

Practice address

401 H St
Suite #3
Chula Vista, CA 91910-4321

Phone

(619) 691-0001

Fax

(619) 691-0111

NPI assigned

Aug 11, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mario Eduardo Eyzaguirre, M.D.NPI 1205866258

Title

Physician/ Ceo

Phone

(619) 691-0001

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 2

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.

• Mario Eduardo Eyzaguirre, M.D.

  • Pediatric Critical Care Medicine Physician
  • San Diego, CA
  • NPI 1205866258
  NPD (past) Authorized official
• Jesus Valencia, PA-C

  • Physician Assistant
  • Chula Vista, CA
  • NPI 1457387730
  NPD (past)

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1265443444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 H ST",
            "address_2": "SUITE #3",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104321",
            "telephone_number": "619-691-0001",
            "fax_number": "619-691-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 H ST",
            "address_2": "SUITE #3",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104321",
            "telephone_number": "619-691-0001",
            "fax_number": "619-691-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO PEDIATRICS & FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "EYZAGUIRRE",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "EDUARDO",
        "authorized_official_title_or_position": "PHYSICIAN/ CEO",
        "authorized_official_telephone_number": "619-691-0001",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A42572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Diego Imaging - Chula Vista, LLC
• San Diego Imaging-Chula Vista LLC
• San Diego Neurosurgery and Spine Institute
• San Diego Orthopedics
• San Diego Pace, LLC (San Diego PACE Chula Vista)
• San Diego Physical Medicine, Inc.
• San Diego Psychiatric Services Inc
• San Diego Radiology Medical Group, Inc.
• San Diego Spine & Sport, Inc (South Bay Spine & Sport)
• San Diego Treatment Services, LLC (Third Avenue Clinic)

• General Practice Physician in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.