NPIMap

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

Organization Active NPI Federally Qualified Health Center (FQHC) · Chula Vista, CA

NPI 1922051812 · NPPES record last updated Sep 12, 2025

Key facts

NPI
1922051812
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
090000136 (CA)
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Practice address
1637 3Rd Ave Suite B, C, F, H & I
Chula Vista, CA 91911-5823
Phone
(619) 662-4100
Fax
(619) 205-1376
NPI assigned
May 19, 2006
Organization subpart
No

Authorized official

Name
Kevin Mattson
Title
President/Ceo
Phone
(619) 662-4100

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 40

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 40

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 34

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

View all 34

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in CA

Federally qualified health center certification: CCN 551966

Legal name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
SAN YSIDRO HEALTH OTAY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 2004
Last certification
Jun 1, 2004
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Feb 5, 1971 in CA
Enrollment address
1637 3Rd Ave
Ste B
Chula Vista, CA 91911-5823

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Tomas Urtasun
Individual 		Corporate Officer
Board Member		 Apr 1, 2010
Guillermo Gomez
Individual 		Corporate Officer
Board Member		 Oct 20, 2012
Magdalena Peraza
Individual 		Corporate Officer
Board Member		 Jul 7, 1997
William Wallace
Individual 		Corporate Officer
Cfo		 Nov 1, 2019
Victor Nieto
Individual 		Corporate Officer
Board Member		 Feb 27, 1999
Reynaldo Perez
Individual 		Corporate Officer
Board Member		 Apr 1, 1995
Antonietta McGuirk
Individual 		Corporate Director Oct 16, 2013
Terry Whitaker
Individual 		W-2 Managing Employee
Coo		 Dec 15, 1998
Centro de Salud de la Comunidad de San Ysidro, Inc.
Organization · San Diego, CA
Non-profit 		5% Or Greater Direct Ownership Interest Feb 5, 1971 100%
Sergio Cuevas
Individual 		W-2 Managing Employee
Dental Director		 Mar 1, 2004
Gloria Ramirez
Individual 		Corporate Officer
Board Member		 Aug 4, 1998
Macario Gutierrez
Individual 		Corporate Officer
Board Member		 May 20, 1975
Kevin Mattson
Individual 		Corporate Officer
Ceo/President		 Apr 29, 2004
Margarita Navarro
Individual 		Corporate Officer
Board Member		 Apr 30, 1997

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
San Ysidro Health CHC-Ocean View
San Diego, CA · CCN 551920		 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2008
San Ysidro Health Euclid
San Diego, CA · CCN 551922		 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2009
San Ysidro Health San Diego Pace/Senior Health Services
San Ysidro, CA · CCN 751102		 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2014
San Ysidro Health El Cajon/San Diego Pace
El Cajon, CA · CCN 751822		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2015
San Ysidro Health South Bay
National City, CA · CCN 751950		 Federally qualified health center 5% Or Greater Direct Ownership Interest (5%) Jun 1, 2016

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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…
O20100713000209 CA Part a Provider - Federally Qualified Health Center (FQHC) 6901709435 Practice locations: Chula Vista, CA
O20191023003400 CA MDPP Supplier - in-Person MDPP Supplier 6901709435 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Diego, CA; San Ysidro, CA; National City, CA; Chula Vista, CA

National Provider Directory

Locations

286 Euclid Ave
Ste 302
San Diego, CA 92114
Phone (619) 527-7330

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 090000136 CA Yes

Addresses

Primary practice location

1637 3Rd Ave Suite B, C, F, H & I
Chula Vista, CA 91911-5823

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
W5740COtherCANORIDIAN MEDICARE PART B
FHC11992HMedicaidCA
551966OtherCANGS MEDICARE PART A

Other names

  • San Ysidro Health Otay Doing business as

Other providers in Chula Vista, CA

All providers in Chula Vista, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.