Healthcare Provider Details

I. General information

NPI: 1841102480
Provider Name (Legal Business Name): LA MAESTRA FAMILY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E MAIN ST
EL CAJON CA
92021-7210
US

IV. Provider business mailing address

1248 E MAIN ST
EL CAJON CA
92021-7210
US

V. Phone/Fax

Practice location:
  • Phone: 619-280-4213
  • Fax: 619-281-6738
Mailing address:
  • Phone: 619-280-4213
  • Fax: 619-281-6738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TOM VU
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 619-972-4165