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Organization
LA MAESTRA FAMILY CLINIC, INC.
Active
Organization
LA MAESTRA FAMILY CLINIC, INC.
Active
Other names
La Maestra Seldovia Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TOM VU (DIRECTOR OF CORPORATE COMPLIANCE)
(619) 269-1292
Entity
Organization
Contact information
Practice address
259 SELDOVIA STREET,, BOX 206, SELDOVIA, AK 99663-0206
(907) 234-7825
(907) 234-7825
Mailing address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 584-1612
(619) 281-6738
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
1011073
AK
363L00000X
Nurse Practitioner
1011073
AK
Other
Enumeration date
10/16/2014
Last updated
09/01/2016
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