Centro de Salud de la Comunidad de San Ysidro, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Chula Vista, CA
NPI 1912950882 · NPPES record last updated Feb 26, 2020
Key facts
- NPI
- 1912950882
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 090000300 (CA)
- Legal business name
- CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
- Practice address
- 865 3Rd Avenue
Suite #133
Chula Vista, CA 91910 - Phone
- (619) 662-4100
- Fax
- (619) 422-0134
- NPI assigned
- May 19, 2006
- Reactivated
- Dec 6, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Gilbert Fimbres
- Title
- Cfo
- Phone
- (619) 205-6331
Other NPIs on the same Medicare enrollment 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 090000300 | CA | Yes |
Addresses
Primary practice location
865 3Rd Avenue
Suite #133
Chula Vista, CA 91910
Mailing address
1275 30TH St
San Diego, CA 92154-3476
Phone (619) 662-4100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC70394F | Medicaid | CA |
Other names
- Chula Vista Family Clinic
Other providers in Chula Vista, CA
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Centro de Salud de la Comunidad de San Ysidro,Inc.
- Centro de Salud de la Comunidad de San Ysidro,Inc.
- Centro de Salud de la Comunidad de San Ysidro,Inc.
All providers in Chula Vista, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.