NPIMap

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

Organization Active NPI PACE Provider Organization · Chula Vista, CA

NPI 1376195040 · NPPES record last updated Jan 27, 2026

Key facts

NPI
1376195040
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
880 3Rd Ave # a
Chula Vista, CA 91911-1305
Phone
(619) 662-4100
NPI assigned
Jul 12, 2019
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 1

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

Other NPIs on the same Medicare enrollment 40

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

View all 40

Corporate family (same tax ID) 4

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

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

Federally qualified health center certification: CCN 921899

Legal name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
SAN YSIDRO HEALTH SAN DIEGO PACE/SENIOR HEALTH SERVICES CHULA VISTA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 3, 2020
Last certification
Nov 3, 2020
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Feb 5, 1971 in CA
Enrollment address
880 3Rd Ave
# A
Chula Vista, CA 91911-1305

All disclosed owners & managing parties 13

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 Director
Board Member		 Apr 1, 2010
Guillermo Gomez
Individual 		Corporate Director
Board Member		 Oct 20, 2012
Magdalena Peraza
Individual 		Corporate Director
Board Member		 Jul 7, 1997
William Wallace
Individual 		Corporate Officer
Cfo		 Jan 20, 2016
Victor Nieto
Individual 		Corporate Director
Board Member		 Jan 27, 1999
Reynaldo Perez
Individual 		Corporate Director
Board Member		 Apr 1, 1995
Antonietta McGuirk
Individual 		Corporate Director
Sr Director of Revenue Cycle		 Oct 1, 2013
W-2 Managing Employee
Sr Director of Revenue Cycle		 Oct 1, 2013
Terry Whitaker
Individual 		Corporate Director
Board Member		 Dec 15, 2018
Sergio Cuevas
Individual 		Corporate Director
Board Member		 Oct 20, 2012
Gloria Ramirez
Individual 		Corporate Director
Board Member		 Apr 1, 1995
Macario Gutierrez
Individual 		Corporate Director
Board Member		 May 20, 1975
Kevin Mattson
Individual 		Corporate Officer
Ceo		 Jul 1, 2002
Margarita Navarro
Individual 		Corporate Director
Board Member		 Apr 30, 1997

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 View
San Diego, CA · CCN 551920		 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2008
San Ysidro Health Euclid
San Diego, CA · CCN 551922		 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2009
San Ysidro Health Otay
Chula 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 Services
San Ysidro, CA · CCN 751102		 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2014
San Ysidro Health El Cajon/San Diego Pace
El Cajon, CA · CCN 751822		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2015
San Ysidro Health South Bay
National City, CA · CCN 751950		 Federally qualified health center 5% Or Greater Direct Ownership Interest (5%) Jun 1, 2016

Medicare enrollment records

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…
O20201201002539 CA Part a Provider - Federally Qualified Health Center (FQHC) 6901709435 Practice locations: Chula Vista, CA

National Provider Directory

Tax ID family
San Diego Pace LLC (5 organizations share this tax ID)
Part of
Centro de Salud de la Comun

Locations

8080 Dagget St
San Diego, CA 92111
Phone (858) 395-3671

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Yes

Addresses

Primary practice location

880 3Rd Ave # a
Chula Vista, CA 91911-1305

Mailing address

8080 Dagget St
San Diego, CA 92111-2333

Other names

  • San Diego PACE Chula Vista Doing business as
  • San Ysidro Health San Diego PACE/Senior Health Services Chula Vista Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 27, 2026.

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769472000000",
    "number": "1376195040",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 3RD AVE # A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111305",
            "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": "2019-07-12",
        "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 Chula Vista",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Ysidro Health San Diego PACE/Senior Health Services Chula Vista",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

All providers in Chula Vista, CA · PACE Provider Organization in California

Sources for this page

Verify at the official NPI Registry.