Organization Active NPI

Clinica Internacional Buena Salud Inc

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1679713192
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CLINICA INTERNACIONAL BUENA SALUD INC
Practice address
3802 National Ave
San Diego, CA 92113-3223
Phone
(619) 264-2591
Fax
(619) 264-4116
NPI assigned
Feb 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Authorized official

Name
Vitali Aizin, MDNPI 1366545733
Title
Director
Phone
(619) 264-2591

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3802 National Ave
San Diego, CA 92113-3223

Mailing address

3802 National Ave
San Diego, CA 92113-3223
Phone (619) 264-2591

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130425000143 CA Part B Supplier - Clinic/Group Practice 1951547637 Receives reassigned benefits from 2 practitioners
Practice locations: San Diego, CA

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
05D1097303Clinica Internacional Buena Salud, Inc3802 National Ave, San Diego, CA 92113Certificate of waiverMar 23, 2027

National Provider Directory

National Provider Directory

Locations

4630 Border Village Rd
Ste H
San Ysidro, CA 92173

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1679713192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3802 NATIONAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921133223",
            "telephone_number": "619-264-2591",
            "fax_number": "619-264-4116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 NATIONAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921133223",
            "telephone_number": "619-264-2591",
            "fax_number": "619-264-4116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA INTERNACIONAL BUENA SALUD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-23",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "AIZIN",
        "authorized_official_first_name": "VITALI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "619-264-2591",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.