| Organization Name: | CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. |
| NPI Number: | 1265843122 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GILBERT FIMBRES (CFO) |
| Mailing Address: | 3364 Beyer Blvd Suite 102 & 103 San Ysidro |
| State: | CA US |
| Postal Code: | 921731322 |
| Phone Number: | 6196624100 |
| Fax Number: | 6196004867 |
| NPI Enumeration Date: | 05/14/2014 |
| NPI Last Update Date: | 03/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |