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General NPI Number Information
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NPI Number | 1053430710
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Entity Type | Organization
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Legal Business Name | LA MAESTRA FAMILY CLINIC INC.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 183 S 1ST ST
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City | EL CAJON
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State | CA
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Zip | 92019-4795
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Country | US
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Telephone | 619-328-1335
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Fax | 619-328-1336
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Provider Business Mailing Address
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Address Line | 4185 FAIRMOUNT AVE
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City | SAN DIEGO
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State | CA
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Zip | 92105-1609
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Country | US
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Telephone | 619-584-1612
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Fax | 619-578-2589
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Authorized Official
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Title or Position | COO
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Name | MRS. ALEJANDRINA AREIZAGA
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Credential |
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Telephone | 619-507-7994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | CA
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