| San Ysidro Health Otay | |
|
1637 3rd Ave Suite B, C, F, H & I Chula Vista CA 91911-5823 | |
| (619) 662-4100 | |
| (619) 205-1376 |
| Full Name | San Ysidro Health Otay |
|---|---|
| Speciality | Clinic/Center |
| Location | 1637 3rd Ave Suite B, C, F, H & I, Chula Vista, 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 Otay 1601 Precision Park Ln San Diego CA 92173-1345 Ph: (619) 662-4100 | San Ysidro Health Otay 1637 3rd Ave Suite B, C, F, H & I Chula Vista CA 91911-5823 Ph: (619) 662-4100 |
| NPI Number | 1922051812 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 03/16/2023 |
| Medicare PECOS PAC ID | 6901709435 |
|---|---|
| Medicare Enrollment ID | O20100713000209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922051812 | NPI | - | NPPES |
| W5740C | Other | CA | NORIDIAN MEDICARE PART B |
| FHC11992H | Medicaid | CA | |
| 551966 | Other | CA | NGS MEDICARE PART A |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 090000136 (California) | Primary |
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