| San Ysidro Health Chc-ocean View | |
|
3177 Ocean View Blvd San Diego CA 92113-1432 | |
| (619) 662-4100 | |
| (619) 428-7952 |
| Full Name | San Ysidro Health Chc-ocean View |
|---|---|
| Speciality | Clinic/Center |
| Location | 3177 Ocean View Blvd, San Diego, California |
| Authorized Official Name and Position | Kevin Mattson (PRESIDENT/CEO) |
| Authorized Official Contact | 6196624100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Ysidro Health Chc-ocean View 1601 Precision Park Ln San Diego CA 92173-1345 Ph: (619) 662-4100 | San Ysidro Health Chc-ocean View 3177 Ocean View Blvd San Diego CA 92113-1432 Ph: (619) 662-4100 |
| NPI Number | 1326225632 |
|---|---|
| Provider Enumeration Date | 01/29/2008 |
| Last Update Date | 11/06/2019 |
| Medicare PECOS PAC ID | 6901709435 |
|---|---|
| Medicare Enrollment ID | O20081021000272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326225632 | NPI | - | NPPES |
| W5740 | Other | CA | MEDICARE PART B PTAN |
| FHC11998G | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 090000143 (California) | Primary |
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