NPIMap

Organization Active NPI

Centro de Salud de la Comunidad de San Ysidro Inc

Doing business as San Ysidro Mountain Empire School Clinic

  • Federally Qualified Health Center (FQHC)
  • Pine Valley, CA
National Provider Identifier
1770117814
Registry record updated Feb 27, 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 Mountain Empire School Clinic
Practice address
3291 Buckman Springs Rd
Pine Valley, CA 91962-4003
Phone
(619) 662-4100
NPI assigned
Feb 27, 2020
Last updated
Feb 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 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 NU Primary

Addresses

Primary practice location

3291 Buckman Springs Rd
Pine Valley, CA 91962-4003

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 205-6349

Other names 1

  • San Ysidro Mountain Empire School Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL EHR Health Information Exchange (HIE)

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

NPI Registry JSON

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1770117814",
    "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": "619-205-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3291 BUCKMAN SPRINGS RD",
            "city": "PINE VALLEY",
            "state": "CA",
            "postal_code": "919624003",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "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": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EHR",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "useOtherDescription": "URL",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EHR",
            "address_1": "3291 Buckman Springs Rd",
            "city": "Pine Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "919624003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "San Ysidro Mountain Empire School Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; 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.