Organization
LA MAESTRA FAMILY CLINIC
Active
Organization
LA MAESTRA FAMILY CLINIC
Active
Other names
LA MAESTRA COMMUNITY HEALTH CENTERS
Organization subpart
No
Provider details
NPI number
Authorized official
ZARA MARSELIAN (CEO)
(619) 584-1612
Entity
Organization
Contact information
Practice address
4185 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1609
(619) 584-1612
Mailing address
4185 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1609
(619) 584-1612
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HAP70472G
SOFP PROVIDER NUMBER
CA
Enumeration date
01/29/2008
Last updated
01/29/2008
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