NPIMap

Organization Active NPI

Imperial Beach Community Clinic

  • Community Health Clinic/Center
  • Imperial Beach, CA
National Provider Identifier
1790718351
Registry record updated May 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
IMPERIAL BEACH COMMUNITY CLINIC
Practice address
949 Palm Avenue
Imperial Beach, CA 91932-1503
Phone
(619) 429-3733
Fax
(619) 429-6457
NPI assigned
Jul 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2010

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

Authorized official

Name
Constance Kirk
Title
Executive Director
Phone
(619) 429-5387

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

949 Palm Avenue
Imperial Beach, CA 91932-1503

Mailing address

PO Box 459
Imperial Beach, CA 91933-0459
Phone (619) 429-3733

Other identifiers 7

IdentifierTypeStateIssuer
40OtherCACOUNTY MEDICAL SERVICES
HAP11826FOtherCAFAMILY PACT
EAP11826FOtherCAEAPC
FHC11826FMedicaidCA
BCP11826FOtherCACDP
FHC11826FOtherCAMEDI CAL
05D0683042OtherLABORATORY CLIA NUMBER

Other names 1

  • Imperial Beach Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040525001394 CA Part B Supplier - Clinic/Group Practice 6709867880 Receives reassigned benefits from 27 practitioners
Practice locations: Imperial Beach, CA
O20100621000058 CA Part A Provider - Federally Qualified Health Center (FQHC) 6709867880 Practice locations: Imperial Beach, CA

Federally qualified health center certification: CCN 051948

Legal name
IMPERIAL BEACH COMMUNITY CLINIC
Doing business as
IMPERIAL BEACH HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 25, 1995
Last certification
Apr 25, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
949 Palm Ave
Imperial Beach, CA 91932-1503

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Monica Jaikaran Individual Corporate DirectorBoard Member May 1, 2016
Bertha Hernandez Individual Corporate DirectorBoard Member May 1, 2012
Rashmi B Savgur Individual Corporate DirectorBoard Member Jan 15, 2025
Mary Coates Individual Corporate DirectorBoard Member Jan 1, 2010
Venissa L Valenzuela Individual Corporate DirectorBoard Member Mar 5, 2020
Henry Santellanes Individual Corporate DirectorBoard Member Nov 1, 2022
Reyna a Puente Individual Corporate DirectorBoard Member Jan 15, 2026
Angel a Lomeli Individual Corporate DirectorBoard Member Jan 15, 2026
Breanna J Reyes Individual Corporate DirectorBoard Member Jan 15, 2026
Veronica Nicole Palomino Individual Corporate OfficerChief Medical Officer Oct 1, 2025
Victoria Gonzalez-Rivera Individual Corporate DirectorBoard Member May 1, 2007
Martha S Ceballos Individual W-2 Managing EmployeeOffice Manager May 21, 2010
Zachary Lambert Individual Corporate OfficerChief Financial Officer Dec 5, 2025
Albert Pacheco Individual Corporate OfficerCeo Jul 1, 2025
Daniela E Sanchez Individual Corporate DirectorBoard Member Jan 15, 2026

Owners & managing parties with NPI records 1

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

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274918400000",
    "number": "1790718351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919330459",
            "telephone_number": "619-429-3733",
            "fax_number": "619-429-6457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "949 PALM AVENUE",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919321503",
            "telephone_number": "619-429-3733",
            "fax_number": "619-429-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL BEACH COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2010-05-27",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "619-429-5387"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNTY MEDICAL SERVICES",
            "identifier": "40",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PACT",
            "identifier": "HAP11826F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP11826F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11826F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDP",
            "identifier": "BCP11826F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI CAL",
            "identifier": "FHC11826F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABORATORY CLIA NUMBER",
            "identifier": "05D0683042",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imperial Beach Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Imperial Beach, CA

Sources for this page

Verify at the official NPI Registry.