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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