Organization
LA MAESTRA FAMILY CLINIC, INC.
Active
Other names
La Maestra Community Health Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ZARA MARSELIAN (CHIEF EXECUTIVE OFFICER)
(619) 584-1612
Entity
Organization
Contact information
Practice address
217 HIGHLAND AVENUE, NATIONAL CITY, CA 91950
(619) 434-7308
(619) 434-7310
Mailing address
4060 FAIRMOUNT AVE, SAN DIEGO, CA 92105
(619) 280-4213
(619) 281-6738
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP71142F
CDP PROVIDER NUMBER
CA
01
—
EAP00011F
EAPC PROVIDER NUMBER
CA
05
—
FHC71142F
—
CA
01
—
HAP71142F
SOFP PROVIDER NUMBER
CA
Enumeration date
10/23/2006
Last updated
12/07/2021
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