Healthcare Provider Details

I. General information

NPI: 1659490308
Provider Name (Legal Business Name): LA MAESTRA FAMILY CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 UNIVERSITY AVE SUITE 150
SAN DIEGO CA
92105-1645
US

IV. Provider business mailing address

4185 FAIRMOUNT AVE
SAN DIEGO CA
92105-1609
US

V. Phone/Fax

Practice location:
  • Phone: 619-501-1235
  • Fax: 619-501-3171
Mailing address:
  • Phone: 619-584-1612
  • Fax: 619-578-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. ALEJANDRINA AREIZAGA
Title or Position: COO
Credential:
Phone: 619-507-7756