NPIMap

Organization Active NPI

Centro de Salud de la Comunidad de San Ysidro, Inc

Doing business as San Ysidro Health Urgent Care

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
National Provider Identifier
1366053167
Registry record updated Sep 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC
Doing business as
San Ysidro Health Urgent Care
Practice address
333 H St Ste 2080
Chula Vista, CA 91910-5558
Phone
(619) 662-4100
NPI assigned
Aug 14, 2020
Last updated
Sep 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2020

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

Authorized official

Name
William Brian Wallace
Title
VP/Cfo
Phone
(619) 205-6339

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

333 H St Ste 2080
Chula Vista, CA 91910-5558

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 662-4100

Other names 1

  • San Ysidro Health Urgent Care 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…
O20210309002330 CA Part A Provider - Federally Qualified Health Center (FQHC) 6901709435 Practice locations: Chula Vista, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366053167. Details of each certification follow.

Federally qualified health center certification: CCN 921906

Legal name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
SAN YSIDRO HEALTH URGENT CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 9, 2021
Last certification
Mar 9, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1971 in CA
Enrollment address
333 H St
Ste 2080
Chula Vista, CA 91910-5558

Other NPIs on the same Medicare enrollment 40

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

View all 40

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
05D2219608San Ysidro Health Urgent Care333 H St, Ste 2080, Chula Vista, CA 91910ComplianceJul 31, 2026

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 24

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

View all 24

Locations

333 H St
Ste 280
Chula Vista, CA 91910

Ownership & related parties

All disclosed owners & managing parties 17

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 DirectorBoard Member Apr 1, 2010
Guillermo Gomez Individual Corporate DirectorBoard Member Oct 20, 2012
Catalina Valencia Individual Corporate DirectorBoard Member Oct 28, 2017
William Wallace Individual Corporate OfficerCfo Jan 20, 2016
Minerva Garcia Individual Corporate DirectorBoard Member Jan 1, 2025
Victor Nieto Individual Corporate DirectorBoard Member Jan 27, 1999
Jairo a Romero Individual Corporate DirectorBoard Member Jan 27, 2023
Reynaldo Perez Individual Corporate DirectorBoard Member Apr 1, 1995
Michael Dew Individual Corporate OfficerManaged Care Director Dec 1, 2021
W-2 Managing EmployeeManaged Care Director Dec 1, 2021
Dave Brooke Individual Corporate DirectorBoard Member Sep 1, 2024
Fred Dorsey Individual Corporate DirectorBoard Member Oct 20, 2016
Kusay I Arabo Individual Corporate DirectorBoard Member Aug 24, 2017
Gloria Ramirez Individual Corporate DirectorBoard Member Aug 4, 1994
Macario Gutierrez Individual Corporate DirectorBoard Member May 20, 1975
Kevin Mattson Individual Corporate OfficerCeo Jul 1, 2002
Thomas David Rodriguez Individual Corporate DirectorBoard Member Jul 1, 2025
Margarita Navarro Individual Corporate DirectorBoard Member Apr 27, 1995

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 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600819200000",
    "number": "1366053167",
    "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": "619-662-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 H ST STE 2080",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919105558",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "619-205-6339"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Ysidro Health Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Ysidro Health Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.