| San Ysidro Health Alpine Family Medicine | |
|
1620 Alpine Blvd Ste 110 Alpine CA 91901-1103 | |
| (619) 662-4100 | |
| Not Available |
| Full Name | San Ysidro Health Alpine Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 1620 Alpine Blvd Ste 110, Alpine, 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 Alpine Family Medicine 1601 Precision Park Ln San Diego CA 92173-1345 Ph: (619) 662-4100 | San Ysidro Health Alpine Family Medicine 1620 Alpine Blvd Ste 110 Alpine CA 91901-1103 Ph: (619) 662-4100 |
| NPI Number | 1770124315 |
|---|---|
| Provider Enumeration Date | 10/04/2019 |
| Last Update Date | 11/06/2019 |
| Medicare PECOS PAC ID | 6901709435 |
|---|---|
| Medicare Enrollment ID | O20200624001258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770124315 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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