Organization
LA MAESTRA FAMILY CLINIC
Active
Other names
La Maestra Community Health Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ZARA MARSELIAN (CEO)
(619) 584-1612
Entity
Organization
Contact information
Practice address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1609
(619) 280-1105
(619) 284-4731
Mailing address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1609
(619) 280-1105
(619) 284-4731
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP70472G
CDP PROVIDER NUMBER
CA
01
—
EAP00011F
EAPC PROVIDER NUMBER
CA
01
—
HAP70472G
FAMILY PACT PROVIDER NUMB
CA
Enumeration date
05/09/2007
Last updated
09/16/2010
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