Organization
LA MAESTRA FAMILY CLINIC, INC.
Active
Other names
La Maestra Community Health Centers, Health Home Care Management Program
Organization subpart
No
Provider details
NPI number
Authorized official
TOM VU (CHIEF OF CORPORATE COMPLIANCE)
(619) 269-1292
Entity
Organization
Contact information
Practice address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 584-1612
(619) 281-6738
Mailing address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
(619) 584-1612
(619) 281-6738
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC70472G
—
CA
Enumeration date
04/29/2019
Last updated
06/11/2019
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