SAN YSIDRO HEALTH CHILDREN'S DENTAL CENTER AT RADY CHILDREN'S HOSPITAL – NPI #1477730737
Clinic/Center

SAN YSIDRO HEALTH CHILDREN'S DENTAL CENTER AT RADY CHILDREN'S HOSPITAL is an AHC clinic located in SAN DIEGO, CA. NPPES has assigned the NPI number 1477730737 to SAN YSIDRO HEALTH CHILDREN'S DENTAL CENTER AT RADY CHILDREN'S HOSPITAL on January 29, 2008. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “SAN YSIDRO HEALTH CHILDREN'S DENTAL CENTER AT RADY CHILDREN'S HOSPITAL” is a dba name, the actual legal business name for this organization is CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

The NPI profile was previously updated about 8 years ago on Nov 06, 2018. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SAN YSIDRO HEALTH CHILDREN'S DENTAL CENTER AT RADY CHILDREN'S HOSPITAL below.

NPI Profile for
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.

NPI Number
1477730737
Enumeration Date

(more than 18 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing Business As (dba): SAN YSIDRO HEALTH CHILDREN'S DENTAL CENTER AT RADY CHILDREN'S HOSPITAL
Primary location
8110 BIRMINGHAM WAY
SAN DIEGO, CA 92123
Phone: (619) 662-4100 Fax: (619) 205-6373
Mailing address
1601 PRECISION PARK LN
SAN DIEGO, CA 92173-1345
Phone: (619) 662-4100 Fax: (619) 428-7952
Organization Subpart
No
Authorized Official
KEVIN MATTSON
PRESIDENT AND CEO
Phone: (619) 662-4100
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)		 CA 550000692

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.