NPIMap

Organization Active NPI

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

Doing business as San Ysidro Health Otay

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
National Provider Identifier
1922051812
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
090000136 Issued in CA
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
San Ysidro Health Otay
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
Last updated
Sep 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • San Ysidro Health Otay Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922051812. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Feb 5, 1971 in CA
Enrollment address
1637 3Rd Ave
Ste B
Chula Vista, CA 91911-5823

Other NPIs on the same Medicare enrollment 40

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

View all 40

National Provider Directory

National Provider Directory

Ownership & related parties

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 OfficerBoard Member Apr 1, 2010
Guillermo Gomez Individual Corporate OfficerBoard Member Oct 20, 2012
Magdalena Peraza Individual Corporate OfficerBoard Member Jul 7, 1997
William Wallace Individual Corporate OfficerCfo Nov 1, 2019
Victor Nieto Individual Corporate OfficerBoard Member Feb 27, 1999
Reynaldo Perez Individual Corporate OfficerBoard Member Apr 1, 1995
Antonietta McGuirk Individual Corporate Director Oct 16, 2013
Terry Whitaker Individual W-2 Managing EmployeeCoo 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 EmployeeDental Director Mar 1, 2004
Gloria Ramirez Individual Corporate OfficerBoard Member Aug 4, 1998
Macario Gutierrez Individual Corporate OfficerBoard Member May 20, 1975
Kevin Mattson Individual Corporate OfficerCeo/President Apr 29, 2004
Margarita Navarro Individual Corporate OfficerBoard Member Apr 30, 1997

Owners & managing parties with NPI records 1

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

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 ViewSan Diego, CA, CCN 551920 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2008
San Ysidro Health EuclidSan 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 ServicesSan Ysidro, CA, CCN 751102 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2014
San Ysidro Health El Cajon/San Diego PaceEl Cajon, CA, CCN 751822 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2015
San Ysidro Health South BayNational City, CA, CCN 751950 Federally qualified health center 5% Or Greater Direct Ownership Interest (5%) Jun 1, 2016

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757635200000",
    "number": "1922051812",
    "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": "619-662-4100",
            "fax_number": "619-428-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1637 3RD AVE SUITE B, C, F, H & I",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919115823",
            "telephone_number": "619-662-4100",
            "fax_number": "619-205-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2025-09-12",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "MATTSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "619-662-4100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "090000136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Ysidro Health Otay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.