| San Ysidro Health Youth Enhancement Services | |
|
1666 Precision Park Ln San Diego CA 92173-1346 | |
| (619) 428-1330 | |
| (619) 482-7952 |
| Full Name | San Ysidro Health Youth Enhancement Services |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1666 Precision Park Ln, San Diego, California |
| Authorized Official Name and Position | Brian Wallace (VP/CFO) |
| Authorized Official Contact | 6196624100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Ysidro Health Youth Enhancement Services 1601 Precision Park Ln San Diego CA 92173-1345 Ph: (619) 428-1330 | San Ysidro Health Youth Enhancement Services 1666 Precision Park Ln San Diego CA 92173-1346 Ph: (619) 428-1330 |
| NPI Number | 1013119569 |
|---|---|
| Provider Enumeration Date | 06/05/2007 |
| Last Update Date | 06/03/2022 |
| Certification Date | 06/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013119569 | NPI | - | NPPES |
| FHC18880F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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