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General NPI Number Information
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NPI Number | 1508949645
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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 | 10/23/2006
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 217 HIGHLAND AVENUE
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City | NATIONAL CITY
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State | CA
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Zip | 91950
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Country | US
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Telephone | 619-434-7308
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Fax | 619-434-7310
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Provider Business Mailing Address
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Address Line | 4060 FAIRMOUNT AVE
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City | SAN DIEGO
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State | CA
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Zip | 92105
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Country | US
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Telephone | 619-280-4213
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Fax | 619-281-6738
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. ZARA MARSELIAN
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Credential |
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Telephone | 619-584-1612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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