NPIMap

Organization Active NPI

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

Doing business as San Ysidro Health Sports Medicine

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
National Provider Identifier
1447836267
Registry record updated Mar 22, 2021
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 Sports Medicine
Practice address
670 L St Ste G
Chula Vista, CA 91911-1065
Phone
(619) 662-4100
NPI assigned
Mar 22, 2021
Last updated
Mar 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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 NU Primary

Addresses

Primary practice location

670 L St Ste G
Chula Vista, CA 91911-1065

Mailing address

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

Other names 1

  • San Ysidro Health Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Chula Vista Family52 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

670 L St
Ste G
Chula Vista, CA 91911

NPI Registry JSON

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

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1447836267",
    "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": "670 L ST STE G",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111065",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-22",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Ysidro Health Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.