| San Ysidro Health El Cajon/san Diego Pace | |
|
875 El Cajon Blvd El Cajon CA 92020-5714 | |
| (619) 662-4100 | |
| (619) 205-6373 |
| Full Name | San Ysidro Health El Cajon/san Diego Pace |
|---|---|
| Speciality | Clinic/Center |
| Location | 875 El Cajon Blvd, El Cajon, California |
| Authorized Official Name and Position | Kevin Mattson (PRESIDENT AND 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 El Cajon/san Diego Pace 1601 Precision Park Ln San Diego CA 92173-1345 Ph: (619) 662-4100 | San Ysidro Health El Cajon/san Diego Pace 875 El Cajon Blvd El Cajon CA 92020-5714 Ph: (619) 662-4100 |
| NPI Number | 1568845741 |
|---|---|
| Provider Enumeration Date | 07/07/2015 |
| Last Update Date | 12/30/2020 |
| Medicare PECOS PAC ID | 6901709435 |
|---|---|
| Medicare Enrollment ID | O20160331002457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568845741 | NPI | - | NPPES |
| W5740 | Other | CA | PART B PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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