| San Ysidro Health South Bay Latino Research Center | |
|
780 Bay Blvd Ste 200 Chula Vista CA 91910-5260 | |
| (619) 662-4100 | |
| Not Available |
| Full Name | San Ysidro Health South Bay Latino Research Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 780 Bay Blvd Ste 200, Chula Vista, California |
| Authorized Official Name and Position | William Brian Wallace (VP/CFO) |
| Authorized Official Contact | 6192056339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Ysidro Health South Bay Latino Research Center 1601 Precision Park Ln San Diego CA 92173-1345 Ph: (619) 662-4100 | San Ysidro Health South Bay Latino Research Center 780 Bay Blvd Ste 200 Chula Vista CA 91910-5260 Ph: (619) 662-4100 |
| NPI Number | 1598492456 |
|---|---|
| Provider Enumeration Date | 08/02/2022 |
| Last Update Date | 03/03/2023 |
| Medicare PECOS PAC ID | 6901709435 |
|---|---|
| Medicare Enrollment ID | O20231116000731 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598492456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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